In 2018, Tricare Select replaced Tricare Standard and Extra.
Choosing the right TRICARE coverage plan for your family is difficult. Each of the TRICARE options is designed to fit the needs of the individual beneficiary.
Understanding the following factors will assist you in determining if TRICARE Select is your best choice.
Why TRICARE Select?
- TRICARE Select Features
- The Cost – Copays and Deductibles
- Getting Help and Hints
TRICARE Select is the TRICARE option that provides the most flexibility to TRICARE-eligible beneficiaries.
It is the fee-for-service option that allows beneficiaries to see any TRICARE-authorized provider. TRICARE Select is not available to active duty service members.
Select shares most of the costs of medically necessary care from civilian providers when military treatment facility (MTF) care is unavailable.
Reasons for Choosing TRICARE Select
Beneficiaries who are happy with the treatment they currently receive from a specific civilian provider that may not be in the TRICARE provider network often choose to use TRICARE Select.
Some beneficiaries, especially retirees under age 65 and their families, may live in areas where the TRICARE Prime network is unavailable, and TRICARE Select may be their only option.
Additionally, retired service members may have employer-sponsored health insurance. TRICARE Select may be used as secondary coverage for these beneficiaries.
TRICARE Select’s Pros & Advantages
- The broadest choice of providers
- Widely available
- No enrollment fee
- No worries about living in a Prime Service Area
Select’s Cons & Disadvantages
- No Primary Care Manager
- The patient pays a deductible and co-payment
- The patient pays the balance if the bill exceeds the allowable charge and the provider is non-participating (up to 15% additional)
- A nonavailability statement may be required for civilian inpatient care for areas surrounding MTFs
- Beneficiaries may have to do their own paperwork and file their own claims
Important Note: The Point of Service annual deductible and cost-share amounts do not count toward your enrollment-year maximum out-of-pocket expense but instead are credited to your fiscal year maximum.
There is no limit to the amount of a patient’s responsibility under the POS option.
TRICARE Select Features
TRICARE Select offers greater provider choice. Beneficiaries may choose any TRICARE-authorized provider.
TRICARE-authorized providers are not required to participate in the TRICARE network; however, they must be certified as authorized providers by the managed care support contractor (MCSC) in that region.
Beneficiaries should contact their regional MCSC to find a TRICARE-authorized provider.
TRICARE Select allows beneficiaries to self-refer for specialty care. Beneficiaries who choose TRICARE Select are not assigned a primary care manager, so, in most cases, they can see specialists without prior authorization.
Some outpatient procedures require prior authorization. Beneficiaries should contact their regional contractor for authorization assistance before seeking care.
For inpatient mental health care, pre-authorization and continued stay authorization requirements apply to Residential Treatment Center care, partial hospitalization program care, and alcoholism detoxification and rehabilitation.
All beneficiaries should contact TRICARE regional contractors regarding potential limits on the length of stay at these facilities.
TRICARE Select beneficiaries living in an MTF catchment area must obtain a non-availability statement from their local MTF before being admitted as an inpatient for mental health services.
Costs for TRICARE Select
Beneficiaries are responsible for cost shares and deductibles for care that is covered under TRICARE Select. Providers participating in TRICARE will accept the TRICARE allowable charge (TAC) as the full fee for services rendered.
However, non-participating providers may charge up to 15 percent above the TAC for their services, and TRICARE Select beneficiaries are financially responsible for these additional charges.
The deductible is based on rank if the soldier is on active duty. In 2023, an E-4 will pay $60 for individual coverage or $121 for family coverage.
Co-payments are anywhere from $18 for a primary care visit to $73 for an inpatient stay. Co-pays for prescriptions are the same as TRICARE Prime for active duty.
Deductibles and co-pays for retirees are higher than for active duty. For instance, a primary care visit is $34. A hospital admission is $250/day and 20% for separately billed charges. Using a non-network facility is much higher.
A “catastrophic cap” is a family’s annual upper limit to pay for TRICARE Select-covered services in any fiscal year. The catastrophic cap for families of active duty service members is $1,217. All others have a catastrophic cap of $3,000.
The catastrophic cap applies only to allowable charges for covered services. The catastrophic cap does not apply to services that are not covered or to the total amount that nonparticipating providers may charge above the TAC.
Getting Help With TRICARE
TRICARE Select has specific rules, and beneficiaries choosing to use TRICARE Select may need to contact the regional contractor call centers toll-free number or a beneficiary counseling and assistance coordinator (BCAC) in their area for assistance.
Customer service staff can answer specific questions about health care benefits, billing, or claims and provide help navigating the Military Health System. TRICARE Beneficiaries may locate a BCAC online.
Helpful Hints on TRICARE Select
Sponsors should ensure their family members have up-to-date uniformed services identification cards and that they are properly enrolled in the Defense Enrollment Eligibility Reporting System (DEERS).* Note: This form can be found in the Important Forms Section
Beneficiaries may be required to file their own claims when using TRICARE Select. Beneficiaries may find more information about filing claims and download claims forms on the TRICARE Web site.
Submit all claims separately; do not bundle multiple claims. Processors manage claims separately; if you send multiple claims together, a problem with one claim will delay payment on all claims.
Although TRICARE Select beneficiaries have a lower priority for access to care in MTFs than TRICARE Prime enrollees, Select beneficiaries may attempt to receive their care from an MTF. This will save them money and paperwork.
Beneficiaries will save money by seeking care from a TRICARE network provider.
TRICARE suggests conducting business online whenever possible, calling during non-peak hours, and visiting TRICARE service centers for face-to-face assistance as ways to beat phone congestion.