TRICARE Prime

The TRICARE Prime program is managed care. It is the most affordable and comprehensive of all TRICARE plans. You choose or get assigned a primary care manager or PCM for short.  Your PCM may be either a military treatment facility (MTF) provider, or a civilian provider who is part of the TRICARE network. If you need special care that your primary care manager cannot provide, he or she will refer you to a specialist.

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Who Is Eligible for TRICARE Prime?

  • Active-duty service members (ADSM)
  • Dependents of active-duty service members (ADFM)
  • Retired service members and their dependents
  • Activated National Guard/Reserve members and their dependents
  • Non-activated National Guard/Reserve members and their families who are eligible for care under Transitional Assistance Management Program
  • Retired National Guard/Reserve members (if 60+ years old and entitled to retirement pay) and their dependents (if not eligible for TRICARE for Life)
  • Surviving dependents
  • Recipients of Congressional Medal of Honor, and their dependents
  • Some qualifying ex-spouses

Benefits Summary of TRICARE Prime

  • Most comprehensive and affordable of all TRICARE plans
  • No out-of-pocket costs for active-duty service members and their families (except for point-of-service fees for family members, if used)
  • Has enrollment fees and cost share for all other beneficiaries
  • Travel reimbursement for some specialty care services received
  • Providers file claim for you
  • Highest priority given to active-duty service members

Coverage Summary

Includes:

  • Outpatient visits
  • Inpatient care (hospitalization)
  • Preventive care
  • Vision care
  • Maternity care
  • Behavioral/mental health care

Enrollment Fees

There is an annual enrollment fee for some TRICARE Prime beneficiaries. The following are exempt from it:

  • Active-duty service members
  • Families of active-duty service members
  • Transitional survivors
  • Beneficiaries below 65 who have Medicare Parts A and B

Enrollment fees are subject to increases based on cost of living adjustments (COLA) that decide military retirement pay.  The following are exempt however:

  • Survivors of deceased active-duty service members
  • Medically retired retirees and their dependents

If one of the above, enrollment fee is frozen for the time when the eligible person was listed in DEERS and enrolled in TRICARE Prime, for as long as the person is enrolled.

Contact your TRICARE regional contractor to find out your enrollment fee, if any.

Cost Summary

Active duty service members
  • $0 at MTF
  • No enrollment fees
  • No cost share in TRICARE network services
  • Highest priority in MTF appointments
Active duty family members
  • $0 at MTF
  • No enrollment fees
  • No cost share in TRICARE network services
Retirees and dependents
  • $0 at MTF
  • Must pay enrollment fees
  • Must pay TRICARE network cost share
  • Lower priority in MTF appointments

 

Availability

TRICARE Prime is available to beneficiaries in Prime Service Areas.  Other TRICARE plan options are available to eligible beneficiaries living in designated remote areas in the U.S. and overseas. These options include TRICARE Prime Remote, TRICARE Prime Overseas and TRICARE Prime Remote Overseas.

 

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