Back to Top Skip to main content

Get to know your TRICARE Prime plan

Take Command of Your Health Take Command of Your Health

Recommended Content:

TRICARE Health Program

TRICARE Prime is similar to a health maintenance organization, or HMO, plan. This means you get most of your care from an assigned or selected primary care manager (PCM). This PCM refers you to specialists for care that he or she can’t provide and works with your TRICARE regional contractor for referrals and authorizations. Depending on where you live and your sponsor’s status, other TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime options include:

TRICARE Prime differs from TRICARE Select, the other TRICARE enrollment health plan. In general, TRICARE Prime offers lower out-of-pocket costs than TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate. TRICARE Select, but fewer personal choices for providers.

Who can enroll in TRICARE Prime?

If you’re on active duty, you’re automatically enrolled in TRICARE Prime. Active duty family members (ADFMs), retirees, and retiree family members may also enroll in TRICARE Prime. In overseas locations, TOP Prime is available to active duty service members (ADSMs) and their command-sponsored family members.

How do you get care with TRICARE Prime?

Under a TRICARE Prime option, you’ll get most of your routine care from your PCM. If you need specialty care, you’ll generally need to coordinate this with your PCM. Certain services require a referral and prior authorization.

If you see a specialist without a referral from your PCM, you’re using the point-of-service option. With the point-of-service option, non-ADSMs can see any TRICARE-authorized provider without a referral. This means that you’ll pay more money to get non-emergency health care from any TRICARE-authorized provider without a referral. ADSMs can’t use the point-of-service option.

What are the costs with TRICARE Prime?

TRICARE Prime generally has the lowest out-of-pocket costs of all the TRICARE health plans. ADSMs and ADFMs pay no deductible and generally have no costs for TRICARE covered services.

Enrollment Costs

ADSMs, ADFMs, and transitional survivors have no enrollment fees. Retirees, their families, and others pay annual enrollment fees.

Costs for Covered Care

ADSMs pay no out-of-pocket costs for covered health care services from a PCM, or with the appropriate referral and prior authorization. ADFMs pay no out-of-pocket costs for covered health care services from a TRICARE network provider in their enrolled TRICARE region, or with the appropriate referral and prior authorization.

Retirees pay copayments or cost-shares for covered health care services from network providers in their enrolled TRICARE region. Out-of-pocket costs are limited to the catastrophic cap amount for that calendar year. For more cost details, check out the TRICARE Costs and Fees Sheet and TRICARE Prime costs. You can also use the TRICARE Compare Cost Tool to compare current plan costs.

Getting to know your TRICARE Prime plan will help you make informed choices and take command of your health this year. To learn more about your health plan and key features, visit TRICARE Prime and download the TRICARE Plans Overview.

You also may be interested in...

National Guard Benefits During Natural Disaster Duty

Presentation
10/1/2018

This brief provides an overview of possible benefits for you and your family if you're placed on state active duty orders for a disaster response

Recommended Content:

TRICARE Health Program

Second chance to register: Join TRICARE for Oct. 11 webinar on new dental, vision coverage

Article
10/1/2018
Take Command of Your Health

If you’re eligible, your first chance to enroll in FEDVIP is during the 2018 Federal Benefits Open Season

Recommended Content:

TRICARE Health Program

National Guard Reserve 2018

Infographic
10/1/2018
This infographic provides an overview of TRICARE benefits and health plan options based on your military status

This infographic describes the plans that National Guard or Reserve Members can enroll in based on their duty station.

Recommended Content:

TRICARE Health Program

Information Sheet for National Guard and Reserve Members 2018

Fact Sheet
9/26/2018

This information sheet describes benefits for certain National Guard and Reserve Members

Recommended Content:

TRICARE Health Program

TRICARE early eligibility and transitional health care benefits

Article
9/26/2018
Take Command of Your Health

Expanded TRICARE Coverage for Eligible National Guard and Reserve Members

Recommended Content:

TRICARE Health Program

Use TRICARE online tools to help you choose a health plan

Article
9/21/2018
Take Command of Your Health

Different family members may be eligible for different plans

Recommended Content:

TRICARE Health Program

TRICARE Open Season 2018

Video
9/19/2018
TRICARE Open Season 2018

TRICARE is establishing an open enrollment season. Watch this video to learn more about what this means for your TRICARE benefit.

Recommended Content:

TRICARE Health Program

Join TRICARE for September 27 webinar on new dental, vision coverage

Article
9/17/2018
Retirees, retiree families, and active duty families are eligible for FEDVIP vision coverage. (U.S. Air Force photo by Senior Airman Jason J. Brown)

Retirees, retiree families, and active duty families are eligible for FEDVIP vision coverage

Recommended Content:

TRICARE Health Program

Voluntary drug recall alert: Valsartan

Article
9/14/2018
Take Command of your health

In July, the FDA issued a voluntary recall of Valsartan, which is used to treat high blood pressure and heart failure

Recommended Content:

TRICARE Health Program

TRICARE DisasterKit 2018

Infographic
9/14/2018
This infographic provides suggestions on items you'll need in the event you have to evacuate your home during a disaster

This infographic provides suggestions on items you'll need in the event you have to evacuate your home during a disaster

Recommended Content:

TRICARE Health Program | Emergency Preparedness and Response

TRICARE Disaster Resources 2018

Infographic
9/12/2018
This infographic provides links to various resources you might need in the event of a disaster.

This infographic provides links to various resources you might need in the event of a disaster.

Recommended Content:

TRICARE Health Program | Emergency Preparedness and Response

MHS Before A Disaster 2018

Infographic
9/11/2018
This infographic provides a list of items you should have on hand in your basic disaster supplies kit in the event a disaster does strike.

This infographic describes the items you should have on hand in a basic disaster supplies kit, in the event that a disaster should strike.

Recommended Content:

TRICARE Health Program | Emergency Preparedness and Response

Retiring from active duty 2018

Video
9/10/2018
Retiring from active duty 2018

Watch this video to learn more about your TRICARE options when you retire from active duty

Recommended Content:

TRICARE Health Program

2019 Monthly Premium Rates for TRS, TRR, and TYA

Policy

Policy Memorandum to Establish 2019 Monthly Premium Rates for TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult

Retiring from active duty? Take action, make an enrollment choice

Article
8/29/2018
When you retire from active duty, you and your family have a change in status. (U.S. Marine Corps photos by Cpl. Cristian L. Ricardo)

When you retire from active duty, your TRICARE plan options will change

Recommended Content:

TRICARE Health Program
<< < 1 2 3 4 5  ... > >> 
Showing results 46 - 60 Page 4 of 10

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.