What is TRICARE Prime?

 

TRICARE Prime is a managed care option only available to you if you live 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. (PSA). You must be TRICARE-eligible to enroll. To check if you’re in a PSA, use the Plan Finder Tool or call your regional contractor. To learn more about TRICARE Prime, visit the TRICARE Prime page. 

Costs:

• You must pay an annual enrollment fee. The fee doesn’t apply if you’re an active duty service member, active duty family member, a transitional survivor, or under the age of 65 with Medicare Part A and Part B. 
• If you’re an active duty service member, an active duty family member, or a transitional survivor, you have no copayments for care you get care from your primary care manager (PCM) or with a referral.
• If you’re a retiree or family member of a retiree, your costs depend on your beneficiary group, and the type of care you get (for example, outpatient care). Use the TRICARE Compare Cost Tool to see your costs.

Providers:

• You will likely have a primary care manager (PCM) at a  military hospital or clinic who provides most of your care. If there isn’t an available military PCM you will have a civilian network PCM. 

Referrals and Authorizations:

• Your PCM must refer you for any care they can’t provide.
• If you're an active duty service member, you need a referral for urgent care, routine, preventive and specialty careSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide..
• All other TRICARE Prime enrollees need referrals for specialty and diagnostic care.
• Your PCM works with your regional contractor for referrals and authorizations.
• If you see a provider without a referral, you will pay more under the point-of-service option.

Covered Services:

Visit the Covered Services page to find out if your service is covered.

Pharmacy Benefits:

Included as part of the TRICARE Pharmacy Program. To learn more, visit the Pharmacy page.

Dental Benefits:

Not included. You may buy separate dental coverage. To learn more, visit the Dental Care page. 

If you're an active duty service member, you have coverage under your active duty dental benefits.

Vision Benefits:

Available but depends on who you are (for example, active duty family member, retiree), and the type of vision care you need. To learn more, visit the Vision page.

You may have the option to enroll in vision coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP). To learn more, visit BENEFEDS.com.