TRICARE Prime is a health care plan under the TRICARE umbrella of plans offered by the Defense Health Agency under the Military Health System. TRICARE Prime Remote functions the same as the original Prime plan but is offered to those service members and their families who live farther from designated Prime geographic areas. Active duty service members are required to enroll in the Prime plan that suits their location and needs, while other uniformed service members may choose to enroll in a Prime plan.
TRICARE Prime providers are either within the military system or are providers within the network. TRICARE Prime coverage is available from a Primary Care Manager (PCM) who provides all general, non-emergency health care services. That PCM can also offer referrals for specialists if required. If you fail to get a referral, then your out-of-pocket costs will increase. It is important that you understand the requirements, enrollment options and coverage benefits of the Prime plans so that you can choose the right one for you.
What is TRICARE Prime?
TRICARE Prime insurance plans offer health care coverage and benefits to qualified uniformed service members and their eligible family members. TRICARE active duty plans are required, meaning that any active duty service member is required to enroll in the appropriate Prime plan based on location and need. Other service members may choose to enroll in a Prime plan, but those who are not active duty will be required to pay annual enrollment fees and other copayments for medical services received.
The TRICARE Prime copay will only be charged to those service members and their families who are not active duty. However, there is a TRICARE Prime cost added if members use the point-of-service option. This happens when members fail to get a referral from their PCM for specialist services. They will, therefore, pay costs out-of-pocket as required.
For more information on benefits, download our free guide.
What does TRICARE Prime cover?
TRICARE Prime benefits include a variety of medical services. Note, however, that not all services are fully covered and that the member’s active duty status will determine costs and coverage availability as well. TRICARE Prime urgent care for non-emergencies can be covered by your PCM, while emergency care will fall under other coverage costs. Active duty service members enrolled in TRICARE Prime will incur no out-of-pocket costs.
As with most plans, TRICARE Prime dental coverage tends to be an additional coverage plan members can choose to add onto to basic Prime coverage. Active duty service members are covered and have access to military dental clinics or civilian services if necessary based on location. If members or their family want extended dental coverage, then they can also look at the three available plans under TRICARE.
Enrolling in TRICARE Prime can be done through the East or West regional contractor, whichever applies to your location. That contractor will also handle all of your claims and overall benefits. You are required to actively enroll since there is no automatic enrollment in the TRICARE Prime plans, even if you are an active duty service member. Also, always make sure to keep your beneficiaries’ details updated in the Defense Enrollment Eligibility Reporting System (DEERS) to ensure that they retain their qualified coverage.
Who qualifies for TRICARE Prime?
TRICARE Prime enrollment is required of all active duty service members. Other uniformed service members can choose to enroll in Prime if that is the best health care plan for them. TRICARE Prime payment, however, is only charged to non-active duty enrollees. Active duty service members pay no enrollment fees or copayments, while those non-active duty service members who opt to enroll in Prime will pay both.
Eligibility for TRICARE Prime ends when you become eligible for Medicare, which is typically when you reach the age of eligibility. At that time, you can look at TRICARE For Life plans if you wish. Otherwise, the following can choose to enroll in a Prime plan:
- Family members of active duty service members
- Retired service members and their families
- Activated Guard/Reserve members and their families (Activated means called or ordered to active duty service for more than 30 days in a row)
- Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
- Retired Guard/Reserve members at 60 years of age and their families
- Medal of Honor recipients and their families
- Qualified former spouses
Remember that active duty service members are required to enroll in the TRICARE Prime plan that is appropriate based on location and availability. The following subsidiary plans can help you to determine which Prime plan is best for you based on your current circumstances and location.
What is TRICARE Prime Remote?
Another version of TRICARE Prime insurance is the Remote option. This is available to qualified service members and their families who live in more remote areas of the United States.
If you are a one-hour drive or 50 miles from any PCM, then you can qualify for the Remote version of the Prime plan instead. This offers the same coverage and benefits as the primary program but also offers increased flexibility in your PCM options given your remote location.
What is TRICARE Prime Overseas?
TRICARE Prime Overseas is the Prime option available to active duty service members and their command-sponsored family members.
If you are on active duty overseas, then you must enroll in this program. This is the primary level of overseas coverage, while certain regions that are considered to be more remote can qualify for the next plan.
Learn About TRICARE Prime Remote Overseas
If members are on active duty in certain areas of the world, then they can qualify for TRICARE Prime Remote Overseas coverage. As with the Prime Overseas plan, active duty service members and their command-sponsored family members can enroll. This offers the same coverage and you can always contact an International SOS agent for assistance with finding a provider or filing a claim.
Download our comprehensive guide on TRICARE to learn more today.