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Which Plan is Right for You? Comparing TRICARE Prime and TRICARE Select

3/22/2018

If you have health coverage with TRICARE, you can choose from a variety of plans, which provide you options in where and how you seek medical and dental services. Two major health programs include TRICARE Prime and TRICARE Select. Both require enrollment and each offer the quality care you deserve. Learn more about the available plans, so you can choose the program or programs that are best for you and your family members.

TRICARE Prime

TRICARE Prime is a managed care option and a health maintenance organization (HMO)-like program. It generally features the use of military hospitals and clinics and reduces out-of-pocket costs for authorized care provided outside military hospitals and clinics by TRICARE network providers. TRICARE Prime is mandatory for active duty service members (ADSMs) and is an option for their family members and certain TRICARE-eligible beneficiaries located in Prime Service AreasGeographic areas in the U.S. where we offer TRICARE Prime. They ensure medical readiness of active duty by adding to the capability and capacity of military hospitals and clinics. Prime Service Areas were also built around the Base Realignment and Closure sites. (PSAs) in the U.S.

In geographical areas where TRICARE Prime is not offered, TRICARE Prime Remote for Active Duty Family Members may be available as an enrollment option for eligible active duty family members (ADFMs). In overseas locations, TRICARE Overseas Program (TOP) Prime and TOP Prime Remote are available to ADSMs and their command-sponsored family members.

The US Family Health Plan (USFHP) is an additional TRICARE Prime option available through networks of community-based, not-for-profit health care systems in six areas of the U.S. To enroll in USFHP, you must live in one of the designated service areas.

Under a TRICARE Prime option, your health care is managed by an assigned primary care manager (PCM) and provided by a military or civilian network provider. Non-active duty enrolled beneficiaries will select or be assigned a PCM. TRICARE Prime PCMs may be:

  • At a military hospital or clinic
  • A civilian TRICARE network provider within a PSA
  • A primary care provider in the USFHP, depending on your location and sponsor status

Whether you receive care in the civilian sector or at a military hospital or clinic will depend on your location and the capacity at nearby military facilities.

TRICARE Select

On Jan. 1, 2018, TRICARE Select replaced TRICARE Standard and TRICARE Extra. TRICARE Select is a self-managed, preferred-provider option for eligible beneficiaries (except ADSMs and TRICARE For Life beneficiaries) not enrolled in TRICARE Prime. TRICARE Select allows you to choose your own TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. and manage your own health care.

Beneficiaries may receive enhanced TRICARE Select benefits from any TRICARE-authorized provider without a referral. You’ll have lower out-of-pocket costs if care is provided by a TRICARE-authorized network provider. Some services require prior authorization. You can also receive certain services from non-network, TRICARE-authorized providers, but will pay higher cost sharing amounts for out-of-network care. TRICARE won’t reimburse you for care received from non-authorized, non-network providers.

Under a TRICARE Select option, you pay a fixed fee for care for most services from a TRICARE network provider instead of paying a percentage of the allowable chargeThe maximum amount TRICARE pays for each procedure or service.  This is tied by law to Medicare's allowable charges.. As mentioned above, using a non-network, TRICARE-authorized provider results in both a higher deductible and out-of-pocket costs. In overseas locations, TOP Select is available to eligible ADFMs not enrolled in TOP Prime and to retirees and their family members. Where the TRICARE network has not been established in an overseas location, TRICARE Select beneficiaries who receive medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. covered services from a non-network, TRICARE-authorized provider will be subject to cost-sharing amounts applicable to out-of-network care.

Take command of your health by making informed decisions about your TRICARE benefit. Learn more about your TRICARE options.


Last Updated 3/27/2018