Tricare Prime is a health care option offered to active-duty military, retirees and others, including families. A managed-network provider, you'll pay low out-of-pocket fees with Tricare Prime.
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Tricare is the military health care provider for military members, retirees and their family members. Whether you are located in the United States or anywhere else in the world, Tricare provides comprehensive health care coverage, prescription programs and dental plans.
But which Tricare plan should you choose?
Here’s a helpful guide on Tricare Prime coverage, enrollment and costs to help you decide if the plan is right for you.
Many “Flavors” of Prime: Tricare Prime, Prime Remote, Prime Overseas, Remote Overseas, Young Adult Prime, and the US Family Health Plan all share HMO-like managed health care features.
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Tricare Prime is a military health care option that works like a health maintenance organization (HMO). HMOs are network-based options that provide health insurance coverage to beneficiaries using contracted providers.
Tricare assigns you to a primary care manager (PCM) when you enroll in Prime or move to a new area. You’ll see your PCM for checkups and basic medical care. If you need specialized care, your PCM must write you a referral before Tricare will cover the charges.
While Tricare determines your PCM, you may be able to request reassignment to a different provider.
Depending on your military status and location, you may have access to Tricare Prime Remote, Prime Overseas, Remote Overseas, Young Adult Prime or the US Family Health Plan. These all function as managed-care Prime plans. In exchange for lower out-of-pocket costs, beneficiaries must use their assigned PCMs in most cases to receive primary care and initialize specialized care referrals.
Active duty service members get Tricare Prime automatically, but lots of others are also eligible to enroll in Tricare Prime.
Here are the categories of people that potentially qualify for Tricare Prime coverage:
Click on the above links to see if you qualify.
Inactive National Guard and reserve service members aren’t eligible for Prime plans but should look into Tricare Reserve Select.
If you’re an active-duty dependent or retiree and don’t want Prime, you can enroll in Tricare Select. However, retirees must transfer to Tricare for Life when at age 65.
Active-duty service members and eligible dependents (spouses and children enrolled in DEERS) pay no out-of-pocket costs for covered in-network services with Prime. For this reason, Tricare Prime often equates to the lowest out-of-pocket costs for the categories.
Active-duty personnel have no enrollment fees, deductibles, network co-pays or point-of-service fees. Non-active duty beneficiaries – including retirees, their families and other Prime eligible members – pay some coverage fees.
Annual enrollment fees differ depending on when the service member entered active duty. Those who entered active duty before 2018 (Group A beneficiaries) will pay an enrollment fee of $177.96 for a single member or $355.92 for a family in 2024. Service members who entered active duty during or after 2018 (Group B beneficiaries) will pay enrollment fees of $564.96 for individual plans and $1,131 for family plans in 2024.
In addition to enrollment fees, all non-active duty service members and their dependents are responsible for paying the catastrophic cap, which is the maximum annual out-of-pocket cost, including deductibles, cost-shares and co-pays.
This is the breakdown of catastrophic caps per Prime service category in 2024, according to Tricare website:
Finally, military treatment facilities (MTFs) fill prescription medications at no cost for Tricare Prime beneficiaries. For those who fill their prescriptions at retail pharmacies or by mail, prices rose slightly as of January 2020 to fund the increasing costs of the Tricare program.
An itemized list of out-of-pocket expenses for 2024 can be found on the Tricare Prime website via their calculator tool.
Besides enrollment fees, if you are not an active-duty service or family member, you will have to pay co-pays, updated as of 2024, including these:
While your enrollment fees are slightly higher, these co-pays are lower than Tricare Select. This is not an exhaustive list.
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To better manage the Tricare system, Tricare has three regions: east, west, and overseas. Different contractors administer your health care services, depending on your location:
To enroll in Tricare Prime, first ensure your DEERS profile is up to date. DEERS enrollment determines Tricare plan eligibility and geographic coverage region.
Remember that enrolling in Tricare Prime or switching health care options is only permitted during open season or other qualifying life events. QLEs include retiring from active duty, the birth of a child, marriage, divorce, a permanent change of station move and other life-changing circumstances.
Before selecting any healthcare option, it’s essential to understand the advantages and disadvantages. Below are several pros and cons of Tricare Prime that will help you to determine what’s best for you:
More information:
Please visit our Tricare Reference Guide for more information on Prime and other Tricare programs.
Meaghan Doherty Myers is a freelance writer, specializing in military benefits, personal finance, and defense and security issues. She holds an M.A. in Strategic Studies and International Relations from the Johns Hopkins School of Advanced International Studies (SAIS) and recently graduated from the Russian language program at the Defense Language Institute in Monterey, CA. She is an Army spouse, a former ballet dancer, and a former management consultant who lives with her husband and daughter in Alexandria, VA.
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