This article provides a comprehensive overview about What is TRICARE and the TRICARE health care system and the kind of coverage it provides.
Who is Eligible for TRICARE?
TRICARE is a program designed to provide health care services to people associated with the United States military in various different capacities – it caters to people, who are currently actively serving in the military forces to people who have retired from their posts in the military, their families and dependent persons, members of the National Guard and Reserve, recipients of the Medal of Honor (as well as their families), former spouses, as well as any other individual who has been enrolled in DEERS, which is the Defense Enrollment Eligibility Reporting System. Thus, in short, there are two main types of beneficiaries: sponsors (which includes people in service, retirees and members of the National Guard and Reserve) and family members (which includes any children or spouses who have been enrolled in DEERS).
The kind of benefits that each person can enjoy and the different plans that an individual is eligible for depend on which category of beneficiaries the individual falls under. The website contains links to direct you to more detailed descriptions and explanations of the benefits and services that each beneficiary category has access to.
What is covered in TRICARE Plans?
All TRICARE plans provide coverage for medical care services that are considered to be necessary or essential and have been proven. At the same time, however, certain rules apply to different medical care services or treatments. There are also certain services and treatments that are not covered in TRICARE plans. The website provides a page where you can enter in a certain service that you wish to enquire about, and it will let you know whether that service is covered or not.
In general, most dental care services are not covered by TRICARE. However, you can visit the page on Dental Care to see what kind of coverage you can receive, which is going to depend on what your current status is. Men and women who can be classified as active duty service members are able to access the dental benefits that cover people who are in service. The family members of active duty family service members and family members of members of the National Guard and Reserve can opt and pay for the TRICARE Dental Program. Men and women who have retired from service and their family members can opt and pay for the TRICARE Retiree Dental Program. Survivors can be catered to by either of the two aforementioned dental programs. As far as members of the National Guard and Reserve are concerned, what kind of coverage they will receive will depend on the military status of their sponsors.
TRICARE and Mental Health Care
Like other health care services, TRICARE plans also cover any mental health care that is necessary. Once again, what kind of care you will receive will also depend on what your current status is. Various services that are provided under mental health care services include acute inpatient psychiatric care, applied behavior analysis, treatment for eating disorders, therapy for the entire family, partial hospitalization (if the need arises) and testing for any psychological problems. There are certain limitations to psychological testing; it cannot be used when the purpose of the test is to determine any vocational or academic placement, to assess an individual’s level of intelligence or for the evaluation of disorders that are not covered by TRICARE plans, such as learning disorders. In addition to this, inpatient or outpatient psychotherapy services are also provided, which can be carried out on an individual basis or in family or group sessions. Collateral therapy, play therapy and psychoanalysis also fall within this category. However, TRICARE plans do not provide coverage for therapy that is carried out for individuals suffering from any kind of disorder associated with sexual functioning or mind expansion therapy.
Furthermore, TRICARE plans also offer the facility of residential treatment centers, which can be used for the extended treatment of children or adolescents who are suffering from various psychological disorders and require treatment in a healthy and therapeutic environment. Under TRICARE plans, individuals can also receive treatment for substance abuse disorders if medically proven to be necessary.
Individuals have access to various treatments, such as those for detoxification, rehabilitation and general therapy, which can be carried out on an outpatient group therapy basis or with the individual’s family. You can visit the specific page dedicated to substance abuse disorders to gain further information about how this treatment works and what coverage TRICARE provides, as there are certain limitations to the number of days that a person can receive treatment for. Tele mental health services are also covered by TRICARE plans.
There are certain procedures and treatments that are not covered by TRICARE plans, such as aversion therapy, behavioral health care, counseling services, psychosurgery, experimental procedures, guided imagery, primal therapy, counseling over telephone, treatment for various development disorders (such as language disorders, mathematics disorders and dyslexia) and transcendental meditation. You can visit the Exclusions webpage under Mental Health Care to obtain the complete list of mental health treatments and procedures that are not included in TRICARE plans.
People with TRICARE plans can also benefit from the Pharmacy Program, which supplies any prescription medications that are needed by individuals and whenever they are needed. This is a very safe and cheap way of obtaining prescription drugs.
Catering to Individuals with Special Needs
The TRICARE health care system has also been designed in a way to include treatment services for people who may have special needs. Beneficiaries have access to applied behavioral analysis, mental health care (which has been discussed above) and cancer clinical trials. In addition to this, home health care is provided, as well as hospice service. Individuals also have access to skilled nursing facilities. However, TRICARE plans do not provide long-term assistance to individuals who require help and support with everyday life and activities.
TRICARE plans may also provide beneficiaries with vision benefits, such as eye examinations. As for other treatments, what kind of benefits a person has access to will depend on his or her current status, the plan that he or she has, as well as his or her age.
How is a Benefit Covered?
TRICARE goes through a detailed process before it makes a certain benefit available to its beneficiaries. To start off, a benefit is first identified that was previously not a part of any treatment plan offered by TRICARE. The next step is to determine whether offering the benefit would be in line with the regulations and laws that are in place.
Besides those, extensive research is carried out in order to see whether the proposed benefit has been proven to be useful and effective, and whether the provision of that benefit will be safe or not. After this is done, TRICARE spends a great deal of effort and energy in evaluating the available clinical data, which would then determine whether this new benefit should be created. If it is decided that there is sufficient clinical data to prove that it would be a wise decision to create this benefit, then the next step comes, which focuses on developing a policy for TRICARE that is going to determine how this benefit will be covered by the health care program.
Once this policy has been devised, we arrive at the crucial step of obtaining funding for the benefit. After funding has been approved that would allow TRICARE to cover this benefit, the existing TRICARE manuals are revised to include the new benefit and fresh copies of the TRICARE manuals are published and distributed. In different regions, TRICARE has support contracts with different health services and facilities. Depending on the nature of the new benefit that has been included in the TRICARE health care program, the next step might involve changing some of these contracts that have been signed with regional health care facilities. After this entire process has been undertaken methodically, the new benefit is made available to the eligible beneficiaries.
Further Information about TRICARE
The kind of health care plan that every individual is using will determine how he or she is able to book an appointment with the doctor. Under a TRICARE Prime plan, the individual can get in touch with his or her primary care manager, who will then be responsible for making the appointment. This primary care manager will also provide the referrals that are needed in situations where the individual has to consult a specialist.
On the other hand, the TRICARE Standard plan users can make their appointments with any provider that has been authorized by TRICARE. They do not need any referrals if they wish to consult specialists, although they might require approval for certain services. The same holds for people who are using the TRICARE Reserve Select plans or TRICARE Retired Reserve plans. People who are using the TRICARE for Life plan can also make their appointments with any provider that has been authorized by TRICARE. For individuals covered by the US Family Health Plan, a certain provider is usually designated.