Ch. 23 Social Health Insurance

What Part A Does Not Cover

- Private duty nursing - Charges for a private room, unless medically necessary - Conveniences, such as a telephone or television in an insureds room - the first three pints of blood received during a calendar year (unless replaced by a blood plan)

What Part B Does not Cover

-Private duty nursing - Skiled nursing home care costs over 100 days per benefit period - Intermediate nursing home care - Physician charges above Medicares approved amount - Most outpatient prescription drugs - care received outside the United States - custodial care received in the home - dental care, routine physical and immunizations, cosmetic surgery, eye glasses, hearing aids, orthopedic shoes, and acupuncture expenses - expenses incurred as a result of war or act of war.

Exercise 23. B

1. Medicaid is a welfare health program intended for the indigent - TRUE 2. Eligibility for Medicaid is set by federal statute - FALSE 3. Medicaid covers most health care costs, including those associated with Medicare, if appropriate. - TRUE 4.Medicaid excludes custodial or nursing home care, like Medicare - FALSE

Exercise 23.A

1. Part C - An alternative to traditional Medicare, Medicare Advantage plans emphasize preventive care 2. Part B- That option part of Medicare designed to pay for doctors services, home health, and certain outpatient medical services supplies 3. Medical Supplements - A program of 10 standardized commercial insurance plans designed to fill the gaps and pay certain costs associated with Medicare 4. Part D - A part of Medicare designed to assist with the cost of prescription drugs. 5. Part A - A part of Medicare ether pays for inpatient hospital care, skilled nursing care, home health care, and hospice care

Workers Compensation

4 Categories of Benefits - Disability (loss of income) benefit - Medical benefits - Survivor (death) benefits - Rehabilitation benefits Disability benefits: compensate for loss of income or earning capacity suffered by individuals injured in their occupation. Payments may be made on a weekly basis, a lump sum bassi, or some combination. Ex. an employee temporarily off work with a broken leg will probably receive a weekly payment based on a percentage of regular wages, subject to an upper limit. Ex. On the other hand, an employee who suffers a permanent loss, such as amputation of a limb, will probably receive a flat lump sum payment based on predetermined schedule in the states workers compensation provisions. Medical Benefits: compensate for the cost of medical treatment resulting from job related injury. In most cases, workers compensation will pay for the full cost of this treatment. Ex Suppose and employee at Spaulding Mattress Manufacturers breaks a leg while on the job and is taken to a. hospital to have it casted. The resulting hospital bills will be payable under workers compensation medical benefits because the employee was injured on the job. Survivor Benefits: Attempt to compensate the widowed spouse or other survivor of an employee whose death results from a job related injury. The amount of the benefit depends on: - The deceased earnings, subject to fixed minimums and maximums - the number of surviving dependents Rehabilitation benefits: are not specifically named in some state workers compensation acts. however, rehabilitation is provided in every state because all states accept the provisions of the Federal Vocational Rehabilitation Act, which provides federal aid toward the costs incurred.

Benefits Under the Original Medicare Plan: Medicare Part A

4 Different Kinds of Care - Inpatient hospital care. (Ex. An individual who is hospitalized with pneumonia) - Skilled nursing facility care (An individual receives skilled nursing services in a facility designed for that purpose. Skilled nursing care is for patients whose professional nursing needs do not require acute hospital nursing care but who need inpatient supervision by a registered nurse) - Home health care (Ex. An individual receives assistance several days a week at home following major surgery) - Hospice Care (An individual with a terminal illness who will spend the remainder of his life in a hospice receives hospice care.

Types of Disability

4 types - Permanent Total - Permanenent Partial - Temporary Total - Temporary Partial If a worker is disabled to the extend that the workers cannot perform any job, this is considered a total disability. If a worker is disabled but able to perform some job, then this is considered a partial disability. Permanent Total Disability - usually results in a complete and permeant loss of earning power, with no ability to perform gainful employment. Certain injuries, such as total loss of sight or loss of both hands or both feet, constitute permanent total regardless of the insureds ability to do some type of work Permanent Partial Disability - Usually refers to a permanent physical impairment that leaves the individual incapable of performing the previous regular job, yet results in only partial loss of earning power because other jobs may be performed. Temporary Total Disability - Usually refers to a total disability that lasts for a short period, after which the employee is fully able to return to work. Ex. Andre strains his back while lifting heavy boxes at work. he is in traction and off work for five months before he is able to resume his former job. Temporary partial disability - Usually refers to a temporary disablement that allows the employee to continue the same job, but with a diminished capability. E. Francesca, who is a photographer and a graphic designer, twists her ankle and is unable to shoot on location. However, she an complete a graphic illustration for her client, sos he is only partially disabled and will be temporarily disable only until her ankle heals.

Medigap Policy

A Medicare supplement insurance policy sold by private insurance companies to fill "gaps" in Medicare Parts A and B. Does not cover C and D. A person who has a Medicare Advantage plan does not need a Medigap policy because the plans cover many of the same benefits. It is illegal to sell both to same person. There are 10 standardized Medigap plans. Each has a letter designation A - N. The benefits in each plan may not be altered by insurers, nor may the letter designation be changed. Medigap Plan A covers basic benefits. Medigap Plans B, C, D, F, G, M, N include the Plan A basic benefits and some extra. Plans K and L offer different benefits than the other Medigap plans and have lower premiums than those plans. However, Plans K and L require higher out of costs from beneficiaries because these plans were designed to give beneficiaries an incentive to control costs.

Hospice Care

A hospice ir organized primarily for the purpose of providing support services to terminally ill patients and their families. For terminally ill patients, the hospice care benefit provides inpatient and outpatient hospice care. Payments are made for pain relief and symptom management but not for curative or other types of treatment. Possible for Medicare to cover hospice care for an unlimited period, as long as a physician certifies need. medicare pays virtually all costs for hospice treatment, with NO DEDUCTIBLE. Only two services require co payments - Prescription drugs, for which patients must pay 5% or $5 per prescription, whichever is less - Respite care, for which patients must pay 5% of the Medicare approved rate up to a specified dollar amount, which changes annually. RESPITE CARE benefit covers temporary care in a hospice for a patient who is normally cared for in the home. The respite is for the usual caregivers and may last no more than 5 consecutive days. Ex. Ellis is admitted to a hospice in March. Medicare begins paying coverage charges immediately, with no deductible required from Ellis. In July and again in October, Ellis is rectified as being terminally ill. Medicare continues to pay hospice benefits for Ellis. During this time, Ellis receives experimental medical treatments that could conceivably halt the progress of his illness. medicare will not cover these treatments, so Ellis must find other funding to pay for them Now lest suppose that Ellis is instead being cared for at home by his brother, who needs some time off from the responsibility of caring for Ellis. If Bradly wants to take Ellis to a hospice or several days, Medicare will pay for five consecutive days of respite care.

Medicare Private Fee for Service Plans

Are similar to the Medicare original fee for service plan, except that they are offered by private companies. The private company rather than Medicare, negotiates with providers to determine how much the lan will pay and what enrollees must pay for the services they receive. Enrolled may have to pay a premium to join the plan and may have to pay other costs, such as co payments, for some services. These costs are different from the costs under the Original Medicare plan. In exchange, enrollees often get extra benefits that are not provided under the Original Medicare Plan, such as extra days in the hospital.

Primary Insurance Amount (PIA)

Benefits available are equal to 100% of the individuals Primary Insurance Amount which is the amount the person would normally receive as retirement benefits. After being entitled to disability benefits for 2 year, an individual may also receive Medicare benefits. Social Security disability benefits are based on the level of a workers earnings up to the time of disbability. However, they are not designed to replace the entire amount of a workers earnings. A workers average earnings are reduced by a formula to calculate primary insurance amount. Benefit amounts re based on the PIA as follows: - A disabled worker receives a benefit equal to 100% of PIA - A spouse caring for the workers unmarried child who is under age 16 or was disabled before age 22 also receives a benefit, equal to 50% of the workers PIA. - Each unmarried child under age 18 or disabled before age 22 receives a benefit equal to 50% of the workers pIA.

Medicare Part D: Medicare Prescription Drug Plans

Coverage is amiable only through private plans that are either stand alone prescription drug plans or Medicare private plans such as HMOs, PPOs, or PFFs. A stand alone plan only offers prescription drug benefits. People in these plans get the remedial services through the Original Medicare plan. Most Medicare Private plans provide all medicare covered services, including prescription drug coverage. Individuals in private fee for service plans that don't offer drug coverage can enroll in stand alone prescritipion drug plan.

Financial Tests

Financial limits vary by state. The recipient must spend down or exhaust income and resources to a minimum amount before Medicaid becomes available. The recipient - an individual, couple, or family - is permitted to retain a small amount of monthly income plus certain assets (law refers to as resources). The recipient is allowed to keep his home. Within important limits, the recipient may also be able to keep some personal property.

Claims and Appeals

If a doctor has no accepted a Medicare assignment, the doctors bill the patients directly. The patient fills out a Medicare claim form and attaches itemized bills from the doctor including date of treatment, place of treatment, description of treatment, doctors name, and charge for service. The form accompanying documents are sent to the Medicare carrier (also known as the fiscal intermediary - a private insurance company) in the patients area. Upon receiving the claim, the carrier sends a form called - EXPLANATION OF MEDICARE BENEFITS. - This form shows which services are covered and the amounts approved for each service.

Home health Care

If a patient is confined at home, the home health care benefit provides for certain services performed by a participating home health care agency. This is a public or private agency that provides skilled nursing or therapeutic services in home. Eligible expenses include: - Intermittent part time nursing care - Physical, occupational, or speech therapy - Home health aids - Medical social services - medical supplies - 80% of certain durable medical equipment, such as wheelchairs or hospital beds. No benefits will be paid for housekeeping services, meal preparation or deliver, shopping, full time nursing care, blood transfusions, drugs, or biologicals. The home health care benefit pays for an unlimited number of home visits as medically necessary, provided they are intermittent rather than constant or full time. Note that this is not the same benefit that is found I long term care policies.

Medicare Employer Coverage

If over 65, group health insurance with be paid as primary and Medicare will be paid as secondary. If under 65, individuals may be entitled to Medicare on the basis of their disability.

Spousal Impoverishment Rule

If the institutionalized spouse has any resources remaining after making a transfer to the spouse, they are applied toward the nursing home biz. Medicaid then pays only the difference between the actual bill form the nursing home and the institutionalized spouses contribution toward that bill out of his income and resources.

Medicare SELECT

Is another version of the standard Medigap policies we have been discussing. it offers the same 12 plans with the same coverages. The only different is that Medicare SELECT is operated on a preferred provider basis. Each insurer has a list of doctors and hospitals from which the insured must make a choice for treatment o receive benefits. As a result Medicare SELECT policies generally have lower premiums than standard medigap policies.

Medicaid

Medicaid is a welfare health care program for indigent persons. it was established by the federal government but is administered by the states. To be eligible : a person must qualify for either 1. Aid for Families with dependent Children (public assistance or welfare) 2. Supplemental security Income an assistance program under Social Security for indigent persons who are age 65 or over, blind, or disabled. For those who do qualify, Medicaid covers most health care costs, including hospital and doctor bills and nursing home care.

Medicare Cost Assistance

Medicaid is required by law to pay the following medicare costs of indigent Medicare patients: - Medicare deductibles - Part B premium - Medicare co payments - Part A premiums (when required)

Home Health Care Services

Medicare Part A covers home health care services. For persons who participate in Part B but not Part A, Part B pays the full cost of medically necessary home health visits for patients requiring home nursing care. The patient pays no deductible or coinsurance, except for 20% of the cost of durable medical equipment provided under the home health care benefit (wheelchair and hospital beds)

Common Deductible ad Co payment

Medicare Part B requires cost sharing by the patient. There is an annual deductible and a coinsurance percentage that applies to all part B covered services across the board. This contrasts with Part A, in which each benefit provided has its own unique co payment requirements for the patient. Under Part B a patients costs are - An annual deductible amount - 20% of all reasonable charges for covered, medically necessary services - The first three pints of blood Medicar determines what is a reasonable charge for a particular service. If the actual charge is more than that, the patient must pay the difference, unless the doctor or supplier agrees to accept assignment ASSIGNMENT means that the doctor or supplier will accept Medicare approved amounts as full payment and cannot legally bill the patient for anything above that amount. They are not required to a accept assignment, but many will.

Medicare

Medicare is the US version of national health insurance, at least as far as the ELDERLY and DISABLED are concerned. To make Medicare benefit payments, the US government enters into contracts with selected private insurance companies. Intermediaries - The insurance companies that make coverage and payment decisions with respect to services provided by hospitals, skilled nursing facilities, home health agencies and hospices are called INTERMEDIARIES. Carriers - The insurance companies that handle claims with respect to services provided by physicians and other providers are called CARRIERS.

Medicare Specialty Plans

Medicare specialty plans provide more focused health care for people with specific conditions. A person who joins one of these plans gets health care services as well as more focused care to mange a specific disease or condition. The goal is to provide quality health care as efficiently and effectively as possible.

Inpatient Hospital Care

Medicares inpatent hospital care benefit helps pay the reasonable charges that result from hospitalization in a semiprivate room for medical necessary care. This includes megs, regular nursing services, special care units, drugs taken in the hospital, tests, medical supplies, operating room, and many other supplies and services. Per benefit period 60 Days - Full Cost Paid, after the patient pays a deductible. 61st - 90 Days - Medicare pays all but a specified coinsurance amount per day. 90 - over Days - the patient may draw upon 60 lifetime reserve days, which may be used only once in a lifetime. The patient daily co payment amount increases substantially when these reserve days are used. A benefit period begins upon admission and ends 60 days after hospital discharge. A readmission during these 60 days is considered part of the same benefit period; a readmission after the 60 days run out is the beginning of a new benefit period.

Medicare Eligibility

Not determined by financial need. Anyone 65 or older as well as many people classified as disabled are eligible for Medicare Part A and Medicare Part B. A person who is eligible for Medicare benefits who: - is age 65 or over and has qualified for Social Security or Railroad Retirement monthly cash benefits - is entitled to benefits under the Social Security program for 24 months as a disabled worker, disabled widow(er), or as a child age 18 or over who was disabled before age 22. - is diagnosed as having permanent kidney failure and requiring dialysis or a kidney transplant or - was born before 1929 and has few or no quarters of coverage under the Social Security system. Survivors and dependents of these individuals may also qualify for Medicare coverage under certain circumstances. A common example is the surviving spouse of an individual who qualified for Social Security before the individuals death. A survivor who is at least age 65 can qualify for Medicare after the spouses death. Pg. 439 for Diagram Examples of people who would be eligible for Medicare: - Chris, age 65, the surviving spouse of Stacy, who was age 68 and eligible for Social Security at the time of death. - Orlando, age 49, who is suffering from kidney failure - Harry age 85, who was born in 1921 and has few quarters of coverage under Social Security

Medicare Enrollment

Part A - Enrollment is free and automatic for individuals entitled to Social Security Benefits. These provisions are eligible for Part A benefits as of the first day of the month in which they reach age 65. It should be noted that individuals who are not eligible for premium free under Part A may be able to purchase it under certain circumstances. Part B - is voluntary and requires payment of a monthly premium. When individuals become eligible for the hospital insurance coverage under Part A, they are enrolled and their premium payment is established for B coverage also, unless they sign. form indicating they do not want the Part B coverage. If individuals enroll before the month in which they reach age 65, Part B coverage begins s of the first day of the month when they are 65, just as it does for Part A. -High income beneficiaries ay higher premiums for Medicare Part B coverage. Premiums are tied to income levels.

Medicare Overview

Part A - Medicare covers inpatient care in hospitals Part B - Doctors services, outpatient care, and some other medical services. Part D - Prescription Drug Coverages Part C - Offers Medicare Advantage Plans, including Medicare managed care plans, such as HMOs, Medicare preferred provider organization plans (PPOs), Medicare private fee for service (PFFS) plans, and Medicare special needs plans. Medicare does not pay for most routine physicals, eye and hearing exams, dental care, and many other medical products and services. Many long term health problems requiring custodial or private nursing care (such as Alzheimers disease are not covered. Medicare coverage is also subject to deductible, co payments, and limitations. The original plan had two parts - Hospital Insurance (Part A) - Medical Insurance (Part B) Part A covers inpatient care in hospitals and skilled nursing facilities, it covers care provided in a hospice and some care provided at home. Part B provides medical insurance for required doctors services, outpatients services and medical supplies, and many services not covered by Part A hospitalization coverage.

Doctors Services

Part B covers most physicians', surgeons, and osteopaths services and supplies furnished as part of such services. Does not where services are provided - in a hospital, in a skilled nursing facility, in a clinic, at the doctors office, at the patients home, or anywhere else in the Untied States. Some services include: - Medical and surgical services, including anesthesia - Office visits, house calls, and hospital calls - Radiological and pathological services provided by a physician - Medical supplies furnished as part of a physicians professionals services - Second opinions before surgery - Diagnostic tests that are part of the patients treatment - x rays - services of the doctors office nurse - physical occupational and speech therapy services - blood transfusion - drugs and biologicals the cannot be self administered Specifically EXCLUDED from Part B - Routine physical exams (does cover 1 physical exam within the first 6 months of enrollment) - Routine foot care, treatment of flat feet, and treatment for subluxations of foot - Eye exams and fitting of eyeglasses or contact lenses - Hearing exams and fitting of hearing aids - most types of dental care - Most immunizations - Cosmetic surgery (unless medically necessary)

Preventive Care

Part B covers the following Preventive services - Bone mass measurements for qualified individuals - Screening blood tests, including cholesterol, lipid, and triglyceride levels, for early detection of cardiovascular disease - Colorectal cancer screenings - Diabetes screening tests for enrollees who are at risk for diabetes - Glaucoma testing once every 12 months - Pap tests, pelvic examinations, and clinical breast exams for women - Annual prostate cancer screenings for men age 50 and over - Annual screening and mammograms for women age 40 and over

Skilled Nursing Facility Care

Per Benefit Period 100 Days - Medicare will share the cost of skilled nursing facility care for up to 100 days. 1- 20 Days - Medicare pays all reasonable charges 21 - 100 Days - The patient must pay a specified dollar amount (coinsurance) Definition: Patient must be receiving medically necessary services provided by a highly skilled staff in a. Medicare approved facility, following a prior hospital stay of at least three days. The care must be of a type that can be performed only by or under the supervision of licensed nursing personnel, and only as the result of a doctors orders. Custodial care or intermediate care is not covered: dressing, eating, bathing help.

Basic Benefits

Plans A, B, C, D, F, G, M, and N The basic benefits policy covers 100% of the Part A hospital insurance amount for each day used from the 61st through the 90th day in any Medicare period. it also covers: - 100% of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period - 100% of the Part A eligible hospital expense for 365 additional days after all hospital benefits are exhausted. - Part B coinsurance amount (generally 20% of Medicare approved expense) after the annual deductible is met - The cost of the first three pints of blood each year an hospice Part A coinsurance Plan K - 100% of Part A hospitalization coinsurance plus coverage for 365 days after medicare benefit ends - 50% fo hospice cost sharing, 50% of Medicare eligible expense for first three pints of blood - 50% of Part B coinsurance, except for 100% coinsurance for Part B preventive services. Plan L - 100% of Part A hospitalization coinsurance plus coverage for 365 days after medicare benefits end - 75% of hospice care sharing - 75% of Medicare eligible expense for the first three pints of blood - 75% of Part B coinsurance, except for 100% coinsurance for Prat B preventive services. PG. 451!!!!!!

Medicare Part C: Medicare Advantage Plans

Plans avail include the following: - Medicare private fee for service plans - Medicare managed care plans - Medicare preferred provider organization plans - Medicare specialty plans The original fee for service plan is still available to all Medicare beneficiaries nationwide. To enroll in a Medicare Advantage plan, a person must be enrolled in medicare Part A and Part B. The enrolled must still pay the monthly part b premium and also may have to pay an additional premium to the Medicare Advantage plan. people who are enrolled in a Medicare Advantage Plan don't need a Medicare supplant policy because they provide many of the same services.

Social Security Disability

Provides death benefits, survivor benefits, retirement benefits, and disability benefits, the last of which is a type of social health insurance. Social Security benefits are available to people who meet these requirements: - Total and permanent disability for at least 5 months - Disability expected to last for at least 12 months end in death - FULLY INSURED and DISABILITY INSURED as defined under Social Security Regulations. FULLY INSURED: means the individual has been credited with the appropriate number of quarters of coverage required by Social Security Laws. DISABILITY INSURED means the individual is fully insured, has the required quarters of coverage, and meets the first two qualifications in the list above.

Medicare Supplement Insurance

Several methods are available to supplement Medicare and cover most of the remaining expenses: - Medicaid, covers expenses no paid by Medicare for eligible low income people. In other words, these people do not need supplemental insurance. - Many employers offer their retiring employees an opportunity to continue their group insurance coverage or to convert it to Medicare supplement coverage. For this who continue to work after age 65, Medicare may become the secondary payer to an employer group health care plan - Associations and groups may offer supplemental Medicare coverage to their members who are age 65 or older - More often, a Medicare supplement policy is purchased from a private insurer to help cover the costs not paid by Medicare. This may also be referred to a Medigap policy.

Medicare Managed Care Plans

Share many of the same features found in managed care plans provided under employer sponsored health plans. They often take the form of Medicare Health maintenance organizations (HMOs). In these HMOs, enrolled ae usually limited to using network providers except for emergencies and may be required to choose a primary care physician. Enrolled who want to see. specialist typically must obtain a referral from their primary care physician. Some Medicare managed care plans offer a Point of Service Plan (POS) option, which allows enrolled to use out of network providers but requires them to pay a greater portion of the providers charges if they do. Medicare HMOS vernally charge enrolls a monthly premium, A small co payment, but usually no additional charges. Enrolled do not have to pay the medicare deductibles and coinsurance amounts, and they often receive coverage for services the original Medicare fee for service plan doesn't cover, such as routine psychical ramen and dental care.

Medicare Preferred provider Organization (PPO)

Similar to Medicare managed health care plans but have the following differences - Enrolles general aren't required to name a primary care physician and can see any doctor or provider that accepts Medicare, but they may pay more if they use providers who arent part of the plans network - Enrolles don't need referrals to see a specialist, although they mayweed plan approval for certain services. PPOs used to bring Medicare Advantage to rural areas.

Exercise 23.C

Social security disability benefits are amiable for workers who are totally and permanently disabled, who are considered fully insured under rules of Social Security, whose disability is expected to last at least 12 months or end in death, after a waiting period of 5 months.

Outpatient Medical Services and supplies

Some outpatient medical services covered under Medicare Part B - Outpatient clinic services - Emergency room services - X rays, whether for therapy or diagnosis billed by the hospital - Medically necessary ambulance services - Purchase or rental of durable medical equipment used in the patients home - Artificial Limbs and eyes - Artificial replacements for internal organs - Braces for neck, back, or limbs - Casts, splints, and surgical dressings - Blood transfusions (after the first three pints) furnished to an outpatient. - Outpatient physical, occupational, and speech therapy provided in therapists office, as an outpatient, or in the patients home - Drugs and biologicals that cannot be self administered - Mammograms Pap smears and colorectal screenings - Diabetes glucose monitoring and eduction - Flu shots Outpatient services not covered by Part B: - Routine physical exams (other than the one time administer 6 months after enrollment) - Eye exams, fitting of eyeglasses or contact lenses - hearing exams and fitting of hearing aids - most immunizations - routine foot care

23. D

Survivor Benefits: Compensates the widow or other dependent family member of an employee whose death results form a work related injury. Medical Benefits: Compensates for the cost of medical treatment resulting from a work related injury Rehabilitation benefits: Servesto reduce insurance losses while restoring the injured workers dignity by preparing the worker to resume gainful employment. Disability Income Benefits: Compensates for the loss of income or earning capacity suffered by individuals injured in their occupation

Benefits under the original Medicare Plan: Medicare Part B

Three general kinds of medical services - Doctors services -Home health care (if not covered by Part A) - Outpatient medical services and supplies. Part B is an optional program of medical insurance designed to supplement Part A. Persons who enroll in Part A are automatically enrolled in part B unless they request otherwise. Part B requires payment of a monthly premium, which many people simply have deducted from their Social Security or Railroad Retirement checks.

Occupational Diseases

To be classified as an occupational disease under a workers compensation law, the disease must meet these requirements: - Arise out of employment - Be due to causes or conditions characteristic of, and peculiar to, the particular trade, occupation, process, or employment.

Compensable Injuries

To be considered compensable an injury must meet three basic criteria: - It must be accidental - It must arise out of the individuals employment - It must arise in the course of the individuals employment.

Tricare

Tricare is a regionally managed health care program for active duty and retired members of the military uniformed services and their families as well as survivors who are not eligible for Medicare. Participants choose among three health care options: - TRICARE standard: a fee for service plan - TRICARE Extra: A preferred provider plan - TRICARE Prime: for those who seek care at military treatment facilities (MTFS)