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 have priority for appointments at the
MTF. Standard beneficiaries are seen on a space-available
- 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.