TRICARE Introduction

 

 

TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. TRICARE brings together the health care resources of the Army, Navy and Air Force and supplements them with networks of civilian health care professionals to provide better access and high quality service while maintaining the capability to support military operations. TRICARE is designed to expand access to care, maintain quality of care, control medical costs for patients and taxpayers alike, and improve medical readiness. TRICARE replaced CHAMPUS, and supplements the military’s health care facilities. TRICARE is modeled after civilian health-maintenance organizations, or HMOs, and is managed by the military, though services are provided by both military doctors and participating contract doctors and facilities.

 

Maine is in TRICARE Region 1. The TRICARE contractor is Sierra Military with web site at http://www.sierramilitary.com.

 

The TRICARE service center managers for Maine are Lori Theriault in Limestone, ME at email ltheriault@sierramilitary.com and Debra O’Brien in Topsham, ME at email do’brien@sierramilitary.com

 

TRICARE offers eligible beneficiaries three choices for their health care:

 

    TRICARE Standard — a fee-for-service option formerly called CHAMPUS. No enrollment is necessary. You may go to any physician you choose, but TRICARE will only pay 80% of a usual and customary fee for each procedure. A non-participating physician may charge up to 115% of this usual and customary fee. This means that you may be responsible for up to 35% of this usual and customary fee for services. You only need to show your ID card to receive care. Some physicians may even process the claim paperwork for you.

 

    TRICARE Extra — a preferred provider option that saves money. No enrollment is necessary. If you elect to go to a physician that has agreed to accept the TRICARE usual and customary fee, TRICARE will pay 85% of this usual and customary fee. This means that you will be subject to pay the remaining 15% of this usual and customary fee.   

 

    TRICARE Prime — where Military Treatment Facilities (MTFs) or Health Maintenance Organizations (HMOs) are the principal source of health care. Enrollment is required. This plan is similar to most HMOs. You only pay a basic co-payment for most services, but you agree to TRICARE Prime sites at:

 

        BNAS Branch Clinic through Sierra Military.

 

        Portsmouth Naval Shipyard Ambulatory Care Clinic through Sierra Military.

 

        Martin’s Point Health Care through the Uniformed Services Family Health Plan (USFHP) (Link to Martin’s Point Health Care HMO) with current sites in Augusta, Bangor, Portland, Topsham and Waterville with more to follow.

 

      TRICARE Prime Remote -- Active duty soldiers who live and work more than 50 miles of a TRICARE Prime site may also enroll in TRICARE Prime Remote. They enroll to a civilian network physician. The active duty soldier pays no fees and the active duty family member pays a small co-payment.

 

The main challenge for most eligible beneficiaries is deciding which TRICARE option, Prime, Extra or Standard, is best for them.

 

Active Duty personnel will enroll in TRICARE Prime and pay no fees.

 

Active duty family members must enroll if they choose TRICARE Prime or TRICARE Prime Remote.  If they do not choose to enroll, and receive care from a physician/dentist that:

    

        DOES NOT participate in TRICARE, they will be using TRICARE STANDARD

 

        DOES participate in TRICARE, they will be using TRICARE EXTRA