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4.6. Medical Care for Retirees

TRICARE offers retiree beneficiaries three options in obtaining medical care:

TRICARE Prime is a health maintenance organization-type managed care program for which retirees are required to pay an annual enrollment fee. Enrollees are assigned a primary care manager who determines the most appropriate available source of care—a military treatment facility or a civilian network provider. Enrollees pay little or no co-payment and are usually not required to file claims for their care.

TRICARE Extra is a preferred provider organization-type (PPO) program. There are no enrollment requirements, but health care must be provided by a TRICARE network provider. You will be responsible for paying annual deductibles and out-of-pocket shares at a reduced rate. The network provider will file your claims for you.

TRICARE Standard is a fee-for-service program that requires an annual deductible and out-of-pocket shares once the deductible has been satisfied. You will be responsible for filing your own claims. Beneficiaries should contact their Health Benefits Advisors/Beneficiary Counselor and Assistance Coordinators (BCAC) at MTFs or stop in at your TRICARE Service Center for more assistance. A counselor locator can be found at www.tricare.mil/bcacdcao/.

If a service member or family member becomes entitled to Medicare Part A, whether due to a disability or when they turn 65, they are eligible for TRICARE For Life (TFL). There are no TFL enrollment fees, but you will be required to pay Medicare Part B premiums (unless the sponsor is on active duty). When using TFL, TRICARE acts as the secondary payer after Medicare in most cases. For more information about TFL, you can visit http://wwww.tricare.mil/tfl.

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