National Academies Press: OpenBook

Substance Use Disorders in the U.S. Armed Forces (2013)

Chapter: Appendix E: Features of TRICARE and Related Purchased Care Plans

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Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

Appendix E

Features of TRICARE and Related Purchased Care Plans

TRICARE Prime

  • Health maintenance organization
  • Active duty service members automatically enrolled
  • Some other beneficiary groups can choose to enroll
  • Some groups have annual enrollment costs
  • Based on a managed care model with an assigned primary care manager and referrals for specialty care
  • Limited co-payments for some beneficiary groups

TRICARE Standard

  • Fee-for-service for non–active duty beneficiaries
  • Does not require pre-enrollment
  • No annual enrollment costs
  • Beneficiary has most options for provider selection
  • Provider can charge usual fees
  • Benefit is a percentage of billed charges after an annual deductible
  • No referrals, some preauthorization
  • Does not require use of network

TRICARE Prime Remote

  • Similar to TRICARE Prime
  • For beneficiaries 50 miles or an hour’s drive from a military treatment facility
  • Primary care manager selected from TRICARE civilian provider network
  • Referrals for specialty care
  • Limited to active duty service members and their dependents

TRICARE Extra

  • Preferred provider organization
  • Fee-for-service plan for non–active duty beneficiaries
  • Does not require pre-enrollment
  • No annual enrollment costs
  • Beneficiary chooses authorized TRICARE provider
  • Benefit is a percentage of allowable charges after an annual deductible
  • No referrals, some preauthorization
Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

TRICARE Prime Overseas

  • Similar to TRICARE Prime when near an overseas military treatment facility
  • Requires enrollment
  • Limited to active duty service members and their Command-sponsored dependents who are living together in a nonremote overseas location (near a military treatment facility)
  • Primary care managers are assigned and make referrals for specialty care

TRICARE for Life

  • Medicare “wraparound”
  • Authorized in 2001 for Medicare beneficiaries who also were eligible for TRICARE benefits (generally retirees and their dependents)
  • Requires Medicare Parts A and B
  • Generally no out-of-pocket expenses

TRICARE Prime Remote Overseas

  • Provides TRICARE-like benefits for active duty service members and their dependents living in remote overseas locations (distant from a military treatment facility)
  • Requires enrollment to participate
  • Divided into Eurasia-Africa, Latin America, and Pacific regions
  • Requires primary care managers who also makes referrals
  • Coordinated by International SOS, a civilian corporation that coordinates overseas health care for DoD

TRICARE Plus

  • New program that allows TRICARE Extra and TRICARE for Life beneficiaries to enroll at a military treatment facility and receive their primary care there
  • No enrollment fees
  • Not all military treatment facilities participate

U.S. Family Health Plan for Non–Active Duty Beneficiaries

  • TRICARE Prime managed care option that evolved from the old Marine Hospital System/Public Health Service Hospitals in the early 1980s
  • Managed by six health care organizations
  • Available to beneficiaries in selected areas of the northeast United States, Washington State, southeast Texas, and southwest Louisiana

TRICARE Young Adult

  • Program for eligible dependents aged 21 (or 23 if enrolled in college full time) to 26 originating in the 2010 Patient Protection and Affordable Care Act

TRICARE Reserve Select

  • Premium-based health plan available to Selected Reserve members of the Ready Reserve (and their dependents) who are not eligible for or enrolled in the Federal Employee Health Benefits program
  • Requires cost sharing
  • No referrals, some preauthorization

Civilian Health and Medical Program of the Uniformed Services

  • Predecessor of TRICARE; began in 1966
  • DoD secretary was authorized to contract with civilian providers to provide health care, primarily to non–active duty beneficiaries
Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

TRICARE Reserve Retired

  • For certain retired Reserve members under age 60
  • Premium-based worldwide health plan that may be purchased by qualified Reserve members and survivors
  • Covers member and dependents
  • Provides choice of providers although out-of-pocket costs vary
  • No referrals, some preauthorization

Federal Employee Health Benefits Program

  • Overall health insurance program available to federal civilian employees
  • Includes various options with a number of insurance carriers
  • Premium-based
Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

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Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×
Page 357
Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×
Page 358
Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×
Page 359
Suggested Citation:"Appendix E: Features of TRICARE and Related Purchased Care Plans." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×
Page 360
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Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade--in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD).

To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM's task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.

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