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MILITARY INSURANCE - TRICARE AND THE VETERANS HEALTH ADMINISTRATION (VA)

TRICARE

TRICARE is the Department of Defense’s healthcare program covering about 10 million active-duty and retired military personnel and their dependents.  It is for the members of the uniformed services—Army, Navy, Air Force, Marine Corps, Coast Guard, Public Health Service, and the National Oceanic and Atmospheric Administration—their families and survivors. TRICARE also offers health care programs for retired service members, including TRICARE Pharmacy and TRICARE for Life.  It is a set of regionally managed health plans available worldwide and managed regionally in two stateside regions in the US—TRICARE East and TRICARE West.  There is one overseas region which contains three areas: TRICARE Eurasia-Africa, Tricare Latin America and Canada and Tricare Pacific.

While most active military patients are treated within the Military Treatment Facilities (MTF), most home infusion providers may treat non-active military, dependents, retired military, etc. covered by the principal TRICARE plans:

*See Copayments and Cost Shares.

**Active duty service men and women are limited to enrollment in the TRICARE Prime programs. The uniformed service directly provides their care through Military Treatment Facilities (MTFs) but may authorize network civilian providers to provide care if the MTF cannot perform the service. Home infusion providers treat active military patients under such authorizations.

Click here for descriptions of all TRICARE health plans and other related information.  Read about eligibility and dual-eligibility. Find out where to file paper claims

Contractors by Regions and Programs:

CMAC Fee Schedules The CHAMPUS National Pricing System (CMAC System) is one of a set of fee schedules used for establishing TRICARE payment. TRICARE provides CMAC look up tools:


Program Manuals
– Accessed from this link or download directly from Health.mil.

VETERANS HEALTH ADMINISTRATION (VA)

The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,298 health care facilities, including 171 medical centers and 1,113 outpatient sites of care of varying complexity, serving 9 million enrolled Veterans each year. Click here to learn more about the VA program.