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...

Cancer Screenings 2019

Infographic
1/30/2019
This infographic lists the types of cancer screenings as part of the TRICARE Health Promotion and Disease Prevention benefit

This infographic lists the types of cancer screenings as part of the TRICARE Health Promotion and Disease Prevention benefit.

Recommended Content:

TRICARE Health Program

Transformation underway across the Military Health System

Article
1/29/2019
Thomas McCaffery, principal deputy assistant secretary of defense for health affairs, with Vice Adm. Raquel Bono, director, Defense Health Agency, celebrated the Defense Health Agency's fifth anniversary on Oct. 1, 2018, by welcoming the first military hospitals and clinics transitioning to the DHA. This was first step for the MHS to emerge as a more integrated and efficient system of health and readiness. (MHS photo by Military Heath System Strategic Communications Division)

All of these changes – the Military Health System transformation, MHS GENESIS, TRICARE enhancements – are aimed at taking the DoD’s health enterprise to the next level

Recommended Content:

Access to Health Care | Health Readiness | TRICARE Health Program | MHS GENESIS | Military Hospitals and Clinics | MHS Transformation

New to TRICARE? The basics you need to know

Article
1/17/2019
TRICARE logo

Learning about your benefit will help you make the most of your coverage

Recommended Content:

TRICARE Health Program

TRICARE Preventive Services

Video
1/14/2019
TRICARE Preventive Services

Watch this video to learn more about all the preventive services your TRICARE benefit covers.

Recommended Content:

TRICARE Health Program | Preventive Health

TRICARE Comprehensive Autism Care Demonstration Program

Congressional Testimony
1/7/2019

S. 2943, SASC Report for FY 2017, 114-255, Pg. 205

Recommended Content:

TRICARE Health Program | Autism Care Demonstration

New codes for applied behavior analysis services begin in New Year

Article
12/18/2018
Take Command of Your Health

Change should not impact beneficiaries, DHA leaders emphasize

Recommended Content:

TRICARE Health Program

Enroll before TRICARE, FEDVIP Open Season closes Dec. 10

Article
12/7/2018
Take Command of your health

Take action, take command and do so before open season closes next week

Recommended Content:

TRICARE Health Program

Know your costs before making a choice during TRICARE Open Season

Article
12/4/2018
Take Command of your health

Before you choose a plan, make sure you know what’s covered and what it costs

Recommended Content:

TRICARE Health Program

TRICARE Prime versus TRICARE Select: Should you change or keep your plan?

Article
11/23/2018
Take Command of Your Health

If you miss open season, you’ll only be able to make enrollment changes within 90 days of a Qualifying Life Event or during the next TRICARE Open Season in fall 2019

Recommended Content:

TRICARE Health Program

Make 2019 enrollment choices today: Open Season underway

Article
11/20/2018
Take Command of your health

The choice you make will take effect Jan. 1, 2019 and will remain in effect through all of 2019

Recommended Content:

TRICARE Health Program

TRICARE open enrollment gives plan choices to beneficiaries

Article
11/14/2018
Navy Vice Adm. Raquel Bono, Defense Health Agency director, said the TRICARE Open Season enrollment period gives beneficiaries a choice in what they want to do with their health care coverage. (MHS file photo)

Open Season gives enrollees in the TRICARE Prime or TRICARE Select plans the opportunity to review their health care options and make changes in coverage based on their needs

Recommended Content:

TRICARE Health Program

TRICARE Open Season questions answered

Article
11/13/2018
Take Command of your health

If you and your family want to make changes to your TRICARE health benefit, take action during the 2018 open season

Recommended Content:

TRICARE Health Program

Expanded TRICARE benefits for certain National Guard members

Article
11/6/2018
Take Command of Your Health

When responding to a state natural disaster, extended TRICARE coverage may be available to National Guard members and their families

Recommended Content:

TRICARE Health Program

Fact Sheet on Expanded TRICARE Benefits for Certain National Guard members

Fact Sheet
11/6/2018

This fact sheet describes the conditions under which a National Guard member may be considered active duty service members under TRICARE.

Recommended Content:

TRICARE Health Program

Expanded TRICARE Benefits for Certain National Guard Members

Presentation
11/6/2018

This brief describes the benefits that certain National Guard members are eligible for when they've received active duty orders for a preplanned mission.

Recommended Content:

TRICARE Health Program
<< < ... 6 7 8 9 10  ... > >> 
Showing results 76 - 90 Page 6 of 12

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.