TRICARE PRIME, STANDARD OR EXTRA:
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TRICARE PRIME
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A plan similar to a civilian Health Maintenance Organization (HMO)
that provides the lowest out-of-pocket cost, in return for the requirement
that enrollees use only doctors, hospitals and other health care providers
who are part of the TRICARE network.
Enrollees are assigned a Primary Care Physician, known generally as a
"Gatekeeper" who supervises all medical care and is the one who authorizes
referrals for specialty care.
Enrollees are charged an annual enrollment fee of $230 per person or
$460 per family and are charged pre-established co-payments depending
on the type of medical care received.
This option may be best for individuals who want guaranteed access to
the most benefits, and who live close to a military hospital or civilian
TRICARE PRIME network.
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TRICARE STANDARD
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Is the new name for the health care option formerly known as CHAMPUS
(Civilian Health and Medical Program of the Uniformed Services).
With TRICARE STANDARD, eligible beneficiaries have the greatest
flexibility in choosing a health care provider and the government
will pay a percentage of the cost. It is chosen most often by
individuals and families who have established relationships they
wish to maintain with civilian physicians.
There is no annual enrollment fee to participate in TRICARE STANDARD.
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TRICARE EXTRA
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Is the Preferred Provider Option (PPO). It offers choices of civilian
physicians and specialists from a network of health care providers. It
is chosen by individuals and families whose regular physician is a member
of the network or who live too far away from a military hospital.
As with TRICARE STANDARD, the government shares the costs of health care.
For using this network of preferred physicians and specialists, the
government will pay an additional 5% of medical costs incurred (85%
for dependents of active duty members and 80% for retirees).
Beneficiaries are free to switch back and forth among providers by using
TRICARE STANDARD or TRICARE EXTRA.
There is no annual enrollment fee to participate in TRICARE EXTRA.
