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TRICARE is a health care policy initiated by the department of defence to offer comprehensive health care coverage. It takes the form of health services, treatment and dental care, TRICARE Pharmacy and TRICARE for Life for uniformed forces’ families and retirees as well as survivors (Jonas & Kovner). TRICARE Prime allows those enrolling to the liberty to request and obtain non-emergency health care services from whichever TRICARE certified resident provider. This is whether the provider is within or outside the Tricare network through the POS Option. In this case, one does not have to request for referral from the Primary Care Manager (PCM) or Health Care Finder (HCF).
Enrolees under Tricare Prime have a right to mutually access military medical services. Moreover, local civilian givers are designed by the commanders of military medical care. Majority of the care is supplied by the Primary Care Manager (PCM). PCM is in charge of their health care needs, maintenance of medical records and when necessary, referring them to specialists. Therefore, every member of the TRICARE prime must always seek views of PCM before reaching for any medication (Jonas & Kovner).
Tricare Prime stands to benefit active duty members and families more since they do not charge any enrolment fee or fee per visit and only a little fee to civilian providers is charged per visit. There is no balance billing for active duty service members’ and families. They are also given the first priority for booking appointments at the MTF before all the Prime enrolees or non-enrolled members. Tricare has efficient access standards for appointments depending on the urgency of the care required since a routine appointment should not wait for more than a week and 28 days in case of a wellness visit.
Tricare has other services like Prime remote and Overseas that cater for service members when they are in areas not accessible to the care. Tricare Prime Remote (TPR) applies to members and their families who are 50 miles away from a MTF, based on geography and eligibility using Zip Code. Under TRICARE Prime, overseas active duty families who are eligible and living abroad (Europe, the Pacific and Latin America/Canada) should enrol as they are likely to stateside. Their enrolment in TRICARE Prime is not obvious for active duty families and therefore the sponsors must act towards signing up their families in Prime. This will ensure that the families do not incur enrolment charges, cost allocations, or any deductibles even when overseas.
Tricare Prime is however limited in terms of area of provider network location and therefore, members in such areas have to incur some charges. Additionally, if an active duty member accesses care from a provider in a non-network without a prior permission from a regional military centre, there will be non-deductible and point-of-service cost shares. This limits the choice of care provider and to some extent the quality (Jonas & Kovner). The fact that Tricare Prime is not available everywhere poses a serious challenge. They also charge enrolment fees for retirees making it difficult for them to become members. The specialty care is only available to referrals and thus being inefficient at times.
On the overall, Tricare Prime provides a low cost medical care compared to Tricare Extra or Tricare Standard. For instance, there is no annual deductible or annual enrolment fee, as well as civilian outpatient visit, inpatient admission and civilian inpatient mental health care cost. In a nutshell, it has assured access to opportune medical care and prioritized care at military hospitals, a PCM who guides the member on healthcare must enrol for a year. However, it is very costly to obtain medical care outside the Point of Service Option, yet Prime is not available in all places (Jonas & Kovner).
Works Cited
Jonas & Kovner. Health Care Delivery in the United States. (2011). Springer Publishing Company. 10th edition. Print.
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