TRICARE Prime
TRICARE Prime offers the most affordable and comprehensive coverage. TRICARE Prime is available in the United States in areas known as Prime Service Areas. Enrollment is required to participate in TRICARE Prime.
Plan OverviewWhen you enroll in TRICARE Prime, you have an assigned primary care manager (PCM), either at a military treatment facility (MTF) or from the TRICARE network, who provides most of your care. Your PCM will refer you to a specialist for care he or she cannot provide and coordinate with your regional contractor for authorization, find a specialist in the network, and file claims on your behalf.
You have certain time and distance standards for care including wait times for urgent, routine and specialty care. Other benefits include enhanced vision and preventive services and travel reimbursement for some specialty care.
Out-of-Pocket CostsActive duty service members and their families pay no enrollment fees and no out-of-pocket costs for any type of care as long as care is received from the PCM or with a referral.
All other beneficiaries pay annual enrollment fees, and the cost for care is based on where the care is received. Care received without a referral is subject to point-of-service fees.
Type of Care
|
MTF
|
Network Provider
|
Outpatient
|
$0
|
$12 per visit
|
Inpatient
|
$0
|
$11 per day
($25 minimum charge) |
Download the TRICARE Summary of Beneficiary Costs Brochure for more details.
Is TRICARE Prime Right for You?If you are an active duty service member or an activated Guard or Reserve member, you must enroll in TRICARE Prime. All other eligible beneficiaries have the option to enroll or use TRICARE Standard and Extra. TRICARE Prime offers fewer out-of-pocket costs than TRICARE Standard and Extra, but less freedom of choice for providers as you must select a provider from the network. So, you should look at your options closely.
Enrolling in TRICARE PrimeOnce you've decided that TRICARE Prime is right for you, you have three options to enroll:
1. Enroll online via the Beneficiary Web Enrollment Web site
2. Mail the TRICARE Prime Enrollment and PCM Change Form for your region to your regional contractor. The mailing address is found on Page 3 of the form:
3. Visit a TRICARE Service Center to submit the TRICARE Prime Enrollment and PCM Change Form.
(from tricare.mil)
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