Understand the 2020 TRICARE® Options

TRICARE is a health care program managed by the Defense Health Agency (DHA) that provides comprehensive coverage to uniformed service members and their families.

Choose TRICARE Prime® From Johns Hopkins USFHP

Johns Hopkins USFHP includes full medical and mental health services, prescription drug coverage, and preventive and routine care—plus extras like discounted services, care management, dental cleanings, and more.

Active-duty family members pay no enrollment fees or out-of-pocket costs for any type of care received through the Johns Hopkins provider network.

TRICARE Prime Benefits

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Annual Enrollment Fees

$0

$300 individual
$600 family

$366 individual
$732 family

Annual Deductibles

$0

$0

$0

Outpatient Services (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Preventative visit

$0

$0

$0

Office Visits (Primary Care)

$0

$20

$20

Specialty office visits

$0

$31

$31

Maternity care
(prenatal, postnatal)

$0

$0

$0

Well-child care (birth to age 6)

$0

$0

$0

Routine physical examinations6

$0

$0

$0

X-ray and lab tests1

$0

$0

$0

Ambulatory surgery
(same day)

All surgical procedures (regardless of where they are performed; excluding some venipuncture and fetal monitoring procedures) and birthing centers (prenatal care, outpatient delivery, and postnatal care)

$0

$62

$62

Physical Therapy
(when medically necessary)

$0

$31

$31

Cardiac Rehabilitation

$0

$31

$31

Inpatient Services (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Hospitalization
(semi-private room and board)

$0

$156/admission

$156/admission

Physician services

$0

$0

$0

General nursing services

$0

$0

$0

Diagnostic tests including lab and X-ray

$0

$0

$0

Operating room, anesthesia and supplies

$0

$0

$0

Medically necessary supplies and services

$0

$0

$0

Physical therapy (when medically necessary)

$0

$0

$0

Mental Health Services (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Outpatient care individual

$0

$31/visit

$31/visit

Outpatient group / family therapy

$0

$31/visit

$31/visit

Partial hospitalization, mental health

$0

$31/visit

$31/visit

Inpatient hospital psychiatric care

$0

$156/admission

$156/admission

Substance Abuse Treatment (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Outpatient care individual

$0

$31/visit

$31/visit

Outpatient group / family therapy

$0

$31/visit

$31/visit

Inpatient services (up to 7 days for detoxification per year)

$0

$156/admission

$156/admission

Residential Treatment Facility

$0

$31/day

$31/day

Partial hospitalization, substance abuse

$0

$31/visit

$31/visit

Other Service (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Ambulance, outpatient ground5 (when medically necessary)

$0

$41/occurrence

$41/occurrence

Ambulance outpatient air5 (when medically necessary)

$0

$20/occurrence

$20/occurrence

Dental Care (basic preventative)

Reduced fees

Reduced fees

Reduced fees

Durable medical equipment

$0

20%

20%

Emergency room services2 (including out of the area)

$0

$62

$62

Urgent Care Center

$0

$31

$31

Routine eye examination (1 per Plan year)

$0

$0

$0

Radiation / chemotherapy office visits

$0

$31

$31

Prescription drug co-pays(up to a 30-day supply - Walgreens Retail)

$13 generic
$33 brand name
$60 non-preferred brand name

$13 generic
$33 brand name
$60 non-preferred brand name

$13 generic
$33 brand name
$60 non-preferred brand name

Prescription drug co-pays(up to a 90-day supply for maintenance medications - Home Delivery & Walgreens Retail)

$10 generic
$29 brand name
$60 non-preferred brand name

$10 generic
$29 brand name
$60 non-preferred brand name

$10 generic
$29 brand name
$60 non-preferred brand name

Skilled nursing facility care

$0

$31/day

$31/day

Home health care (part-time skilled nursing care)

$0

$0

$0

Out of area (emergency services only)

$0

$62

$62

Catastrophic cap (Maximum out-of-pocket expense per family)

$1,000/enrollment year (Group A*)
$1,044/enrollment year (Group B**)

$3,000/enrollment year

$3,655/enrollment year

*For enlistment or appointment prior to January 1, 2018 / **For enlistment or appointment after January 1, 2018
1
If lab services are provided on the same day as the office visit and a co-pay is collected for the visit, no additional co-pay will be collected. No co-pay will be collected when services are billed and provided as clinical preventative services. Exceptions: Co-pay may be required for certain radiation oncology, vascular and pulmonary procedures and studies. Contact Customer Service for details.
2
Unless you are admitted to the hospital, in which case only the inpatient co-payment applies.
3
Prescription drug availability is limited to drugs prescribed by a Plan provider and covered as a Plan benefit. Availability of non-emergency prescriptions when out of the area is also limited. Over-the-counter medications and supplies are not covered. Retail vendors for prescriptions are Walgreens pharmacies.
4
Outpatient treatment following the initial intake evaluation and testing is limited to a maximum of 36 sessions per cardiac event.
5
Routine Physical Examinations – while there is no co-pay for a Routine Physical; an office visit co-pay may be assessed if other procedures (not considered routine) are conducted during the examination.