BOX 2-1
TRICARE Prime and Other TRICARE Programs

TRICARE has a number of program options, depending on beneficiary category (e.g., active duty servicemember, active duty family member, military retiree, eligible retiree family member, survivor, qualifying former spouse, reserve members and family members, and retired reserve members and their families) and geographic location relative to military treatment facilities (MTFs) (TRICARE, 2012).* For purposes of this report, the important distinction is whether a TRICARE beneficiary (1) must enroll in TRICARE Prime at an MTF; (2) may enroll in TRICARE Prime at an MTF; and (3) may use an MTF on a space-available basis although not enrolled in TRICARE Prime.

Must Enroll in TRICARE Prime. Active duty servicemembers within the catchment of an MTF (which is within a 40-mile radius of the MTF) must enroll in TRICARE Prime at the MTF and receive all health care at the MTF unless referred out by their primary care manager. Therefore, all enlisted recruits and students at Naval Station Great Lakes are enrolled in TRICARE Prime at the Captain James A. Lovell Federal Health Care Center, as are active duty staff members who live within a 40-mile radius.

May Enroll in TRICARE Prime. Active duty family members, retirees ineligible for Medicare and their family members, survivors, and qualifying former spouses may enroll in TRICARE Prime rather than TRICARE Standard, TRICARE’s fee-for-service option. The incentive for enrolling in TRICARE Prime, similar to a managed care plan or health maintenance organization, rather than TRICARE Standard or other options, is lower out-of-pocket costs. Active duty

family members.1 More than 83 percent of DoD health care beneficiaries used TRICARE services in fiscal year (FY) 2010.

The MHS comprises 59 inpatient hospitals, 363 ambulatory care clinics, 281 dental clinics, and 255 veterinary facilities. It employs more than 139,000 people, including 32,000 officers, 54,000 enlisted personnel, and 53,000 civilians.

The care is provided either by military hospitals, called military treatment facilities (MTFs), or by non-DoD providers under contract, called TRICARE network providers. Those who enroll with an MTF, through TRICARE Prime, pay an annual enrollment fee but do not have to pay deductibles or copayments. Those who go to other providers, through TRICARE Standard, must pay deductibles and copayments but may choose


1 The information and quotes in this section come from the Department of Defense (DoD, 2011a,b), unless otherwise indicated.

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