TRIC ARE Coverage for Retired Service Members by den54914



Coverage for Retired
Service Members

                   An overview

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                                                            Transitioning from
                                                            Active Duty to
                                                            When you retire from active service and
                                                            begin drawing retired pay, one chapter in
                                                            your life ends and another begins. TRICARE
                                                            changes with you. Your coverage options
                                                            change, allowing you more choice and
                                                            flexibility to meet your new health care
                                                            needs as a uniformed services retiree.

                                                            It’s important to understand the choices
                                                            available to choose the best option for you
                                                            and your family. Use this guide to make the
                                                            best decision about your health care
                                                            through the stages of your retirement.

An Important Note About
TRICARE Program Changes
At the time of printing, the information in this brochure
is current. It is important to remember that TRICARE
policies and benefits are governed by public law.
Changes to TRICARE programs are continuous, and
new benefits are added regularly as we continue to
make TRICARE a better program for you. For the most
recent information, visit

                               1-888-DoD-CARE (1-888-363-2273)
Enrolling in
When your status changes from active duty to
retired, you must re-enroll to continue your
TRICARE Prime coverage and pay an annual
enrollment fee. Upon re-enrolling in TRICARE
Prime, your TRICARE Prime benefits will remain
the same. You and your family and survivors
receive complete coverage. However, as a
retiree enrolled in TRICARE Prime, an annual
enrollment fee and copayments in the network
will apply.
Access to Care
As long as you receive care at a military treatment
facility (MTF), you and your family will not be
responsible for any copayments for primary or
specialty care services.
For care received from a TRICARE network
provider, certain copayments will apply.
See the TRICARE Costs for Retirees chart later in
this booklet for more information about your            Enrollment Portability
family’s TRICARE Prime costs and fees after you         For retirees and their families who may be part-time
transition to retirement.                               residents in different regions, TRICARE Prime
                                                        gives you the ability to transfer your TRICARE
MTF Priority System                                     Prime coverage to another TRICARE region. You
A priority system has been established for access       can transfer your TRICARE Prime enrollment
to health care at an MTF. Briefly, the priorities are   twice during a single enrollment year without
as follows:                                             paying additional enrollment fees as long as the
                                                        second transfer is back to the original location.
1   Active duty service members
                                                        For retiree families living in separate regions,
                                                        TRICARE Prime offers a great deal of flexibility
2    Active duty family members enrolled in
     TRICARE Prime
                                                        under the split enrollment feature. With split
                                                        enrollment, you can enroll your family in multiple

3    Retirees and their family members and
     survivors enrolled in TRICARE Prime
                                                        TRICARE regions while you continue to pay only
                                                        one family enrollment fee.

4    Family members of active duty service
     members NOT enrolled in TRICARE Prime
                                                        For more information on how to enroll in TRICARE
                                                        Prime, see the TRICARE Choices booklet. You can

5    All other eligible persons, including
     retirees and their families NOT enrolled
     in TRICARE Prime
                                                        request a copy from your regional contractor or
                                                        from a TRICARE Service Center.

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TRICARE Extra and
TRICARE Standard
If you decide not to enroll in TRICARE Prime upon       Access to Care at an MTF
retirement, TRICARE Extra and TRICARE Standard          If you and your family decide not to enroll in
options also are available to you.                      TRICARE Prime, you may continue to access care
                                                        from an MTF as long as capacity exists at a
Access to Civilian Care                                 particular facility.*
through TRICARE Extra
With TRICARE Extra, a preferred provider option         *TRICARE Plus is an MTF primary care enrollment
                                                        program offered at some MTFs and available to those
(PPO), you and your family can continue to seek care    beneficiaries who are not enrolled in TRICARE Prime or
from any TRICARE network provider. You are              a civilian HMO. Check with your local MTF for details.
responsible for discounted cost-shares after the
annual deductible has been met. See the TRICARE         MTF Priority System
Costs for Retirees chart for more details.
                                                        MTF Priority System
Access to Civilian Care
through TRICARE Standard                                A priority system has been established for access to
With TRICARE Standard, a fee-for-service option,        health care at an MTF. Briefly, the priorities are as
you and your family have the freedom to seek care       follows:
from any provider you choose—as long as he or
she is TRICARE-authorized. You are responsible          1    Active duty service members

for cost-shares (5 percent higher than TRICARE Extra)
after the annual deductible has been met. See the
TRICARE Costs for Retirees chart for more details.
                                                        2   Active duty family members enrolled in
                                                            TRICARE Prime

                                                        3   Retirees and their family members and
                                                            survivors enrolled in TRICARE Prime

                                                        4   Family members of active duty service
                                                            members NOT enrolled in TRICARE Prime

                                                        5   All other eligible persons, including retirees
                                                            and their families NOT enrolled in
                                                            TRICARE Prime

                                                        Access to Care Overseas
                                                        If you plan to live overseas after you retire, you and
                                                        your family may have access to MTFs overseas on
                                                        a space-available basis. You will no longer be able
                                                        to enroll in TRICARE Prime but will be covered
                                                        for all health care under TRICARE Standard. The
                                                        same annual deductibles and cost-shares as the
                                                        stateside program will apply.

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TRICARE Costs for Retirees
                                TRICARE Prime                      TRICARE Extra**                TRICARE Standard**

 Annual* Enrollment Fee         $230/individual $460/family        None                           None

 Annual* Deductible             $0/individual $0/family            $150/individual or             $150/individual or
                                                                   $300/family                    $300/family
                                Unless point-of-service
                                option is used

 Annual* Catastrophic Cap       $3,000                             $3,000                         $3,000

 Civilian Outpatient Visit      $12 copayment per visit            20% of negotiated rate         25% of allowed charges
 Copayment                                                         after the deductible is met    for covered service after
                                                                                                  the deductible is met

 Clinical Preventive            $0 copayment/service               Applicable deductible and      Applicable deductible and
 Services                                                          cost-shares apply per          cost-shares apply per
                                                                   service                        service

 Civilian Inpatient             $11 per day                        $250 per day or 25% of the     $459 per day or 25% of
 Cost-Share                     ($25 minimum charge                negotiated rate for            the negotiated rate for
                                per admission)                     institutional services,        institutional services,
                                                                   whichever is less, plus 20%    whichever is less, plus 25%
                                                                   of separately allowed          of separately allowed
                                                                   professional charges           professional charges

 Emergency Services             $30 copayment per visit            20% of negotiated rate         25% of allowed charges

 Civilian Outpatient            $25 (individual visit)             20% of negotiated              25% of allowed charges
 Behavioral Health              $17 (group visit)                  rate after the deductible      after the deductible is met
                                                                   is met

 Civilian Inpatient             $40 per day                        20% of the negotiated rate     Low-volume hospitals: The
 Behavioral Health                                                 for institutional services,    lesser of $164 per day or
                                                                   plus 20% of separately         25% of hospital billed
                                                                   allowed professional           charges
                                                                   charges                        High-volume hospitals:
                                                                                                  25% of hospital-specific
                                                                                                  per diem

 Inpatient Skilled Nursing      MTF: $13.32 per day                MTF: $13.32 per day            MTF: $13.32 per day
 Facility Care                  Civilian: $11 per day              Civilian: Lesser of $250       Civilian: $459 per day or
                                ($25 minimum charge                per day or 20% of the          25% of allowed charges
                                per admission) (No separate        negotiated fee for             for institutional services,
                                copayment/cost-share for           institutional services, plus   plus 25% of separately
                                separately billed professional     20% of the negotiated          allowed professional
                                charges.)                          professional fee.              charges

*Annual fees are aligned with the fiscal year
(October 1–September 30).
** Cost-shares reflecting a dollar amount are subject to change.

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Using the
TRICARE Pharmacy Program
Filling Your Prescriptions                               Pharmacy Copayments
TRICARE provides a world-class pharmacy benefit
                                                          Place of Service         Your Costs
to retirees and their families and survivors. Upon
retirement, your pharmacy coverage does not change.       Military Treatment       $0
TRICARE offers several convenient ways for you            Facility Pharmacy
and your family members to get prescriptions filled.
                                                          TRICARE Mail Order       $3 generic drugs
MTF Pharmacy                                              Pharmacy (TMOP)             (up to a 90-day supply)
You may have prescriptions filled at any MTF                                       $9* brand name
pharmacy free of charge if the MTF stocks the                                          (up to a 90-day supply)
prescription you need. MTF pharmacies will accept a       TRICARE Retail           $3 generic drugs
written prescription from any TRICARE-authorized          Network Pharmacy            (up to a 30-day supply)
provider.                                                 (TRRx)                   $9* brand name
                                                                                       (up to a 30-day supply)
TRICARE Mail Order Pharmacy (TMOP)
TMOP is available for prescriptions that you take on      Non-network              $9* or 20% of total cost,
a regular basis. TMOP allows you to mail your             Pharmacy                 whichever is greater**
written prescription, along with the appropriate                                   (up to a 30-day supply)
copayment, to TMOP and the medications will be
sent directly to you. Prescriptions may be refilled by   * Some prescriptions may be classified as “non-
mail, phone, or online.                                  formulary.” In these cases, you will be responsible for
                                                         a $22 cost-share with TMOP or in the TRICARE retail
TRICARE Retail Pharmacy Network                          network pharmacy. In non-network pharmacies, you
                                                         will be responsible for a $22 cost-share or 20 percent,
You may have prescriptions filled at any TRICARE         whichever is greater.
network pharmacy for a small copayment.
                                                         **Existing deductibles and point-of-service (POS)
                                                         cost-shares apply for beneficiaries enrolled in TRICARE
Non-network Pharmacy                                     Prime; check for details.
Using a non-network pharmacy is the most costly
option and is not recommended. If you must use a
non-network pharmacy, you will need to pay for your
medications up front and then file a claim with
TRICARE for reimbursement.
For more information about TRICARE’s pharmacy
options, use the contact information on the back of
this brochure.

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Using the
Dental Program
                                                     Choosing a Dentist
                                                     The TRDP network has more than 67,000
                                                     participating dentists. Using a participating TRDP
                       Comprehensive Dental
                                                     dentist, such as those in the DeltaSelect USA or
                       Coverage for You and          DeltaPreferred Option USA networks, will result in
                       Your Family                   lower out-of-pocket costs than using the non-network
                                                     participating dentists in the DeltaPremier USA
                                                     network. However, you are free to seek dental
                                                     treatment from any DeltaPremier USA dentist and
You and your family are encouraged to consider       still receive benefits. DeltaPremier USA network
the TRICARE Retiree Dental Program (TRDP),           dentists have agreed to file your claims and follow
offered by the Federal Services division of Delta    Delta’s quality assurance requirements.
Dental Plan (DDP) of California. The enhanced
                                                     You also may seek dental treatment from any
dental benefits offered with TRDP are the most
                                                     licensed dentist of your choice. If you visit a non-
comprehensive and cost-effective dental coverage
                                                     network dentist, the same coverage percentages and
ever available to retirees and their family
                                                     benefit levels will apply, but you will have to pay
                                                     the dentist and then submit a claim to Delta for
Enrollment                                           reimbursement.
Enrollment is voluntary and open to retirees and     For more information about enrolling in TRDP and
their family members, certain surviving family       for a complete list of fees and covered services, use
members of deceased active duty sponsors, and        the contact information on the back of this
Medal of Honor recipients and their immediate        brochure.
family members and survivors.
Coverage Area
The TRDP offers dental coverage throughout the
50 United States, the District of Columbia, Puerto
Rico, Guam, the U.S. Virgin Islands, American
Samoa, the Commonwealth of the Northern
Mariana Islands, and Canada. Premiums vary
depending on where you live.

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Uniformed Services
Family Health Plan
The Uniformed Services Family Health Plan           When enrolled in the USFHP, members do not
(USFHP) is another TRICARE Prime option             access Medicare, MTFs, or TRICARE network
available to retirees and their eligible family     providers, but instead receive their care from a
members, including those age 65 and over,           primary care physician selected by the beneficiary
through networks of community-based hospitals       from a network of private physicians affiliated
and physicians in six areas of the country.         with one of the not-for-profit health care systems
                                                    offering the plan. If enrolled in the USFHP, you
To enroll in the USFHP, you must submit a           are restricted from using services within the
completed application to the USFHP program          military health system (MTF or TRICARE
of choice. Enrollees must reside in one of the      network providers), including the TRICARE
service areas listed below.                         pharmacy program.
 Johns Hopkins Community Physicians                 For more information call 1-800-74-USFHP
 1-800-808-7347                                     (1-800-748-7347) or visit
 Serving central Maryland and parts of    
 Pennsylvania, Virginia, and West Virginia

 Martin’s Point Health Care
 Serving Maine and New Hampshire

 Brighton Marine Health Center
 Serving central and eastern Massachusetts,
 including Cape Cod and Rhode Island

 Saint Vincent Catholic Medical Centers
 Serving parts of New York, all of New Jersey,
 eastern Pennsylvania, and southern Connecticut

 Christus Health
 Serving southeast Texas and southwest Louisiana

 Pacific Medical Centers (PacMed Clinics)
 Serving the Puget Sound area of Washington State

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Becoming Eligible for
When you become entitled to Medicare Part A due          TFL Covered Services
to age, disability, or end-stage renal disease and you
                                                         • For services covered by both Medicare and
purchase Medicare Part B, you become eligible for
                                                           TRICARE, Medicare will pay first and
TRICARE For Life (TFL), TRICARE’s Medicare-                TRICARE pays second.
wraparound coverage. With TFL, TRICARE pays
secondary to Medicare for services covered by            • For services covered by TRICARE but not
both.                                                      Medicare, TRICARE will pay its portion and
                                                           you are responsible for applicable TRICARE
You will be notified about changes in your                 deductibles and cost-shares.
TRICARE benefits, and the Social Security
                                                         • For services covered by Medicare but not
Administration (SSA) will notify you regarding
                                                           TRICARE, Medicare is the only payer, and you
your Medicare entitlement. If you have any
                                                           are responsible for Medicare cost-shares.
questions contact the SSA for assistance.
                                                         • For services not covered by Medicare or
Medicare provides you with a Medicare card                 TRICARE, you are responsible for the entire
indicating you have coverage from both Medicare            bill.
Part A and Part B.
If you currently only have Medicare Part A, you
may enroll in Medicare Part B during the General         Access to Care
Enrollment Period, which runs from January 1st to        You may visit any TRICARE-authorized provider
March 31st each year. The Part B coverage for new        who accepts Medicare. Check with your regional
enrollees begins on July 1st of the year you enroll.     contractor (Health Net Federal Services, Inc.,
For more information about enrolling in Medicare         Humana Military Healthcare Services, Inc.,
Part B:                                                  or TriWest Healthcare Alliance) to see if your
                                                         provider is TRICARE-authorized.
• Phone: 1-800-772-1213
• TTY/TDD: 1-800-325-0778 for the                        Access to Care Overseas
  hearing impaired                                       If you’re living overseas, you may use TFL as
• Visit the SSA online at                    long as you purchase Medicare Part B. Since
                                                         Medicare does not typically provide health care
                                                         coverage overseas, TRICARE provides the same
                                                         TRICARE Standard benefits available to retirees
                                                         under age 65, and beneficiaries are responsible
                                                         for the TRICARE Standard cost-shares and

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Keeping Your Eligibility
Up to Date
If you have a change in your status, such as retiring
from active duty or becoming Medicare eligible,
be sure to update your records in the Defense
Enrollment Eligibility Reporting System (DEERS)
database. You can update your address in DEERS
using one of the following methods:
• Visit a uniformed services personnel office.
  The nearest one can be located online at
• Call 1-800-538-9552 (Monday–Friday 6 a.m.
  to 3:30 p.m. PST except federal holidays).
• Fax address changes to DEERS at
• Mail address changes to:
  Defense Manpower Data Center Support Office
  Attn: COA
  400 Gigling Road
  Seaside, CA 93955-6771
• Update addresses electronically at

16                         1-888-DoD-CARE (1-888-363-2273)
For Information and Assistance
TRICARE North Region Contractor
1-877-TRICARE (1-877-874-2273)
TRICARE South Region Contractor
TRICARE West Region Contractor
1-888-TRIWEST (1-888-874-9378)
TRICARE Overseas
(TRICARE Europe,TRICARE Latin America
and Canada, and TRICARE Pacific)
DEERS—Verify Eligibility
TRICARE Mail Order Pharmacy Program
1-866-DoD-TMOP (1-866-363-8667)
TRICARE Retail Pharmacy Program
1-866-DoD-TRRx (1-866-363-8779)
TRICARE Retiree Dental Program
TRICARE Information Service
1-888-DoD-CARE (1-888-363-2273)

          TRICARE Worldwide Coverage

                 West       North

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