TRICARE Prime®

TRICARE Prime is a managed care option available in Prime Service Areas.

• Check the Plan Finder to see if you live in a Prime Service Area.
• Enrollment is required.
• Some beneficiaries pay annual enrollment fees.

Additional TRICARE Prime options for active duty service members and their families include:

• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas 

Who Can Participate

• Active duty service members and their families
• Retired service members and their families*
• Activated National Guard and Reserve members and their families
• Non-activated National Guard and Reserve members and their families who qualify for care under the Transitional Assistance Management Program
• Retired National Guard and Reserve members at age 60 and their families*
• Survivors
• Medal of Honor recipients and their families
• Qualified former spouses

*When retired service members and their families become eligible for Medicare based on age, they aren’t eligible to enroll in TRICARE Prime.

How It Works

You have an assigned primary care manager who provides most of your care. Your PCM:

• Could be a military provider or civilian network provider
• Refers you to specialists for care they can’t provide
• Works with your regional contractor for referrals and authorization 
• Accepts your copayment and files claims for you

What You Pay

• Active duty service members: No enrollment fees or out-of-pocket costs for covered care
• Active duty family members: No enrollment fees or network copayments. Point-of-service fees may apply.
• Retirees and other beneficiaries: You pay an annual enrollment fee and network copayments. Point-of-service fees may apply.

See TRICARE Prime Costs

Point-of-Service Fees

If you get nonemergency care without following referral rules, you’ll pay point-of-service fees instead of your usual copayment. These fees are much higher.

POS fees include:

• An annual deductible: $300 per individual or $600 per family
• Cost-shares: 50% of the TRICARE-allowable charge after you meet your POS deductible
• Additional charges: You may have to pay amounts charged by non-network providers above the TRICARE-allowable charge.

POS fees don’t count toward your annual catastrophic cap.

Note: If you’re an active duty service member, POS fees don’t apply to you. But you must still follow your plan’s referrals and pre-authorization requirements.

Is TRICARE Prime right for you?

• If you’re on active duty, you have to enroll in TRICARE Prime.
• All others can choose to enroll in TRICARE Prime or TRICARE Select.
• TRICARE Prime offers fewer out-of-pocket costs than TRICARE Select, but less freedom of choice for providers.
• If you have other health insurance, TRICARE Prime might not be right for you.

How To Enroll

Visit TRICARE Prime Enrollment to learn more.

For information on disenrolling or ending plan coverage, visit Disenrolling From TRICARE Prime.

Change My PCM

Other TRICARE Prime Options

Active duty family members, retirees and their family members, and certain others may also be eligible for one of these TRICARE Prime options:

• Uniformed Services Family Health Plan: A TRICARE Prime option administered by participating nonprofit plans in six service areas in the U.S.
• TRICARE Prime Demo: A managed care option available to eligible beneficiaries in Atlanta, Georgia, and Tampa, Florida