* Updated January 2016
TRICARE Prime is the HMO-type health care plan that covers all uniformed service members. An active-duty service member is automatically covered by TRICARE Prime (even so, he/she must fill out and turn in an enrollment form that records his Prime coverage).
- Many active-duty family members choose to enroll in Prime. There are no enrollment fees, deductibles, or co-payments. If they choose not to enroll, they are covered under Standard.
- Retirees and retiree family members and survivors (under age 65) also may choose to enroll in Prime. They pay an enrollment fee and small co-pays. If they choose not to
enroll in Prime, they are covered under Standard.
- Prime enrollees receive most health care at the MTF, where their care is supervised by a primary care manager (PCM). MTF services are augmented by a network of “preferred” or “in-network” providers, who are managed by one of the three TRICARE regional contractors. Standard beneficiaries can make appointments with any authorized
provider of their choice.
- Prime enrollees must adhere to certain rules regarding their health care: For specialty care, for example, they must receive a referral from their PCM and then get an authorization for care from the regional contractor. For most specialty care, Standard beneficiaries make their own appointments with the provider of their choice.
- Prime enrollees do not deal with paperwork claims; their claims are filed for them by the provider. Standard beneficiaries often must file their own paperwork claims.
- Prime enrollment is not universally available. In areas where Prime and TRICARE Prime Remote are not available, beneficiaries are covered under TRICARE Standard.