Tri-Care Research Paper

From what I've read Tricare is different in many was,Tricare Standard provides benefit like the original champus program and is available to retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. It's is also available to Reservist and their family under the Tricare Reserve Select Component. Being under Tricare Standard, beneficiaries can use any civilian health care provider that is payable under Tricare regulations. Beneficiary is responsible for payment There's no enrollment fee for Tricare Standard. Tricare Standard beneficiaries can elect to use the Tricare Extra option by using a civilian health care provider from within the regional contractor's provider network. Tricare Extra represents a PPO.

Once enrolled sponsors and beneficiaries are automatically enrolled in two of the three plans in the Tricare program. These are known as Tricare Standard, a fee for service plan, and Tricare Extra, a PPO plan. Most enrollees owe co-payments and deductibles under these plans. Under the PPO plan no referral or authorization is required to see a specialty

Tricare Standard - An option that provides flexible coverage for eligible beneficiaries. It allows beneficiaries to choose an authorized Tricare provider they desire. However; this option isn't available for active military members. Eligible participants include: family members of active military, retired military and their family, survivors, authorized past spouses, and Medal of Honor donee and their family. There are no monthly premiums, or fees to enroll but this plan does have an annual deductible and a cost-sharing or copay. If you're a Rank E4 and below the cost is $50 per person, $100 per family. Rank E5 and above the cost is $150 per person, $300 per family.

TRICARE Standard is the choice that provides the most to the eligible beneficiaries. It’s a fee-for-service option that gives beneficiaries the opportunities to see any TRICARE approved provider. Even though TRICARE Standard is not available to the active duty service members, it is available worldwide. Some people who are eligible for TRICARE Standard are Active duty family members, survivors or former spouses who are qualified.

RICARE Standard was developed as a fee for service program that covers medical services provide by a civilian physician when the individual cannot receive treatment from a military treatment facility and when an individual has to seek care from a civilian provider, the TRICARE Standars benefits go into effect.

Wholeheartedly agree with your assessment on the Veterans as a major issue, and an issue that will unfortunately continue to grow in the coming years.

TRICARE is formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), and is a health care program of the US Department of Defense Military Health System. Following WWII and the Korean War, access to care in military facilities became less available by civilians and active-duty personnel due to a lack of resources, or a constraint of them, and growing demands on the system, and “space-available basis” was first addressed. As a solution, Congress passed the Dependents Medical Care Act in 1956 and the Military Medical Benefits Amendments in 1966. Such acts allowed the Secretary of Defense to work with civilian health care providers and contract their services. This health civilian health care program became known as the CHAMPUS in 1966. The responsibility of maintaining the health care initiative within the Military lies upon the U.S. Department of Defense Military Health System, which organized the Tricare Management Activity (TMA). The TMA consists of a contract-structure between several large health insurance corporations to provide claims processing, customer service and other administrative functions to the TRICARE

Tricare Standard plan allows a beneficiary to choose his or her own provider. There’s plenty of choices and individuals that have the freedom of seeing any non-network provider that they wish to consult. Under the TRICARE Standard health care plan, they will be required to make their own appointments.

The US has recently adopted a healthcare policy aimed to get more Americans insured. This policy is named the Affordable Care Act in 2010. “In 2013 there were 42 million uninsured individuals in the United States. “(The Common, pg. 153) There has since been increase in individuals who are covered either by private insurance or by Medicaid/Medicare which had a coverage increase with the new policy. It is believed that millions of people will now have health insurance compared to previous years.

Tricare Standard is the basic plan- you are automatically enrolled and do not pay a monthly premium, charges that the patients are

Case Management Society of America. (2010). Standards of Practice for Case Management. Retrieved from http://www.cmsa.org/portals/0/pdf/memberonly/StandardsOfPractice.pdf

Tricare is a health care policy for those in the military, their families, and retirees. Tricare is managed by the defense department. Tricare covers the uniformed services, including the Army, Navy, Marines, Air Force, Coast Guard, Public Health Service, and National Oceanic and Atmospheric Administration. Tricare compromises families three choices of health care benefits which consist of Tricare prime this is a health maintenance organization, Tricare extra which is a managed care network or health care providers that families can use on a case-by-case basis without a required enrollment and Tricare standard which is a fee-for-service plan. Tricare also offers a plan for those Medicare eligible military retirees and Medicare eligible family members. This program offers the opportunity to receive health care at a military treatment facility for individuals aged 65 or older who are eligible for both Medicare and Tricare. Tricare billing consists of several elements which are; check in process information that is needed such as benefit verification, pre-authorizations, and forms used, coding from the medical such as what forms are needed for the process of coding, then a scenario with the actual ICD-9 and or CPT codes, the type of claim forms that were used and the claims verification process and finally, the claims payment process such as verification and accuracy of payment. Also the possibility of rejection and how to resolve issues that may become present.

Healthcare in the United States has reached a level of complexity which has perplexed Presidents, Congressional members and private industry for over a century (Palmer, 1999). While the healthcare system has evolved over the last century, policy decisions which have attempted to effectuate changes to cost, quality and access have been

After doing my research and trying to differentiate between all the TRICARE plans it seems as though it can be quite difficult on deciding which plan is best. There are just so many different options and plans that are for specific types of military personnel. Some plans should be chosen with consideration to location of the active duty member and their family. It would be best to stick with the Prime plan in most situations but other plans may need to be added as a supplement to ensure out of pocket costs are kept low for families. The positive aspect is that there are many choices and ways to keep everyone in the family covered and at a low cost. It would be helpful for military personnel and their family members to have a class

States have chosen to two forms of Medicaid managed care to better deliver healthcare services besides the traditional fee-for-service Medicaid programs; primary case management and traditional health maintenance organizations. “In primary care case management, the state Medicaid agency contracts with a primary gatekeeper entity (e.g., physician, clinic) that coordinates primary and specialty care for Medicaid beneficiaries. For healthcare maintenance type programs, a State Medicaid agency contracts with an existing healthcare maintenance organization, prepaid health plan, or other institutional health care provider who, in addition to proving primary care services, assumes insurance risk of providing covered services. Typically primary case management are paid on a fee-for-service basis plus a monthly case management fee per enrollee, while health maintenance organization plans are paid a capitation rate and are at full financial risk.” (1)