Tricare Prime Overview
TRICARE Prime
TRICARE Prime is a managed care option offering the most affordable and comprehensive coverage. Enrollment is required.
TRICARE Prime is minimum essential coverage under the Affordable Care Act.
Tricare "At A Glance" Infographic
Eligible Beneficiaries
Beneficiaries who may enroll in TRICARE Prime include:
- Active duty service members and their families
- Retired service members and their families*
- Activated National Guard/Reserve members and their families
- Non-activated National Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
- Retired National Guard/Reserve members (age 60 and receiving retired pay) and their families*
- Survivors
- Medal of Honor recipients and their families
- Qualified former spouses
*When retired service members and their families become eligible for TRICARE For Life, they are no longer able to enroll in TRICARE Prime.
Availability
TRICARE Prime is available in the United States in designated Prime Service Areas Geographic areas in the United States where TRICARE Prime is offered. Prime Service Areas were created to ensure medical readiness of the active duty force by augmenting the capability and capacity of military hospitals and clinics. Prime Service Areas were also built around the Base Realignment and Closure (BRAC) sites. Other Prime options are available for active duty service members and their families in remote U.S. areas and overseas.
Coverage
TRICARE Prime provides comprehensive health coverage including:
- Emergency Care
- Outpatient Visits
- Preventive Care (wellness exams, immunizations, etc.)
- Hospitalization
- Maternity Care
- Mental/Behavioral health
- Prescriptions
When enrolled, you'll also enjoy enhanced preventive care and vision benefits.
Getting Care
With TRICARE Prime you have an assigned primary care manager (PCM), either at a miltary hospital or clinic 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 Costs
Active duty service members and their families have 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 network copayments.
Is TRICARE Prime Right for You?
- Active duty service members and activated Guard/Reserve members 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 Prime
1. Enroll online via the Beneficiary Web Enrollment Website
2. Mail the TRICARE Prime Enrollment and PCM Change Form to your regional contractor. Select your region below; 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.
