TRICARE and Veterans Health Administration (VHA)

Introduction

• TRICARE: Military health insurance program

  • Covers military personnel and immediate family
  • Available to all 7 United States service branches
  • Requires registration in DEERS (Defense Enrollment Eligibility Reporting System)

• Veterans Health Administration (VHA): Largest integrated health care system in the US

  • Overseen by the Office of the Under Secretary for Health
  • Annual budget ~$68 billion

TRICARE Overview

• Eligibility: Active-duty members, retirees, dependents
• Beneficiaries: Military personnel (sponsors) and their families

Types of TRICARE

1. TRICARE Prime

   • Similar to an HMO
   • Requires primary care provider (PCP)
   • Annual enrollment fee and cost-share
   • No need to file claims

2. TRICARE Extra

   • Flexible access to TRICARE network providers (TNPs)
   • Pays 20% of authorized costs after deductible
   • Providers file claims

3. TRICARE Standard

   • Greatest flexibility, highest cost
   • Covers services from most providers
   • 25% cost-share
   • Non-participating providers can charge additional fees

4. TRICARE for Life

   • Secondary insurance to Medicare for retirees over 65
   • Covers costs not paid by Medicare

Coverage

• Hospitalization, outpatient visits, preventative, maternity, mental health care
• Immunizations, surgeries, pre-existing conditions, prescription drugs
• Limitations on certain procedures (e.g., abortions, cosmetic surgery)

Eligibility Criteria

• Various military status qualifications, including:
  • Active duty, retired, veterans with certain honors or disabilities
  • Family members of veterans

Veterans Health Administration (VHA)

• Mission: Provide exceptional healthcare to America's veterans
• Facilities: 1,255 healthcare facilities, including medical centers and clinics
• Services
  • Preventative care, inpatient services, urgent and emergency care
  • Mental health services, rehabilitation, prescriptions

Exclusions

• Certain procedures not covered (e.g., cosmetic surgery, gender reassignment)

Key Terms

• Healthcare Systems (HCS): Regional networks of medical centers
• Community-Based Outpatient Clinics (CBOC): Local clinics for outpatient services
• Community Living Centers (CLC): Skilled nursing facilities
• Vet Centers: Offer readjustment counseling
• Veterans Integrated Services Network (VISN): Regional systems for local healthcare needs

Conclusion

• TRICARE and VHA provide comprehensive healthcare to military personnel and veterans
• Understanding eligibility and coverage is crucial for beneficiaries

Thank you for tuning in to learn about TRICARE and the VHA. We hope this overview provided valuable insights into the health coverage options for military personnel and veterans.