There are two TRICARE options you can choose from when selecting your military health insurance coverage. One option is called TRICARE Prime, the other is TRICARE Select. Which option is right for you? It depends on the circumstances, as we’ll examine below.
TRICARE Prime
This TRICARE option is described on the official site as a managed care plan for those living in Prime Service Areas within the USA.
When you enroll in Prime, you get a primary care manager who may be a military doctor or a civilian care provider offering services within the network. Under TRICARE Prime, your primary care manager:
- Refers you to specialists for care the PCM can’t provide
- Works with your regional contractor for referrals
- Works with your regional contractor for authorizations
- Accepts your copayment
Your PCM also provides you with a fixed dollar amount you will pay for a covered health care service, and will file TRICARE claims on for you. In addition to TRICARE PRIME, the following options are also available:
- TRICARE Prime Remote is for troops and families living outside of a PSA
- TRICARE Overseas Program Prime and TRICARE Overseas Program Prime Remote is for service members and “command-sponsored family members” living overseas
- The US Family Health Plan is for those living in one of six areas in CONUS.
TRICARE requires you to enroll, and some may be required to pay an annual fee.
Who Qualifies for TRICARE Prime?
- Active duty service members and families
- Retired service members and families
- Troops activated or ordered to active duty service
- Retired Guard/Reserve members at age 60 and their families
- Surviving spouses and dependent children
- Medal of Honor recipients and their families
- Qualified former spouses
- Guard/Reserve members and their families
- Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
Read more: Ultimate TRICARE Guide
How Much Does TRICARE Prime Cost?
Active duty service members pay nothing out-of-pocket. Active duty family members pay nothing unless using the point-of-service option. Most other TRICARE enrollees are responsible for network co-pays and annual fees. Actual costs vary from year to year; see the TRICARE official site for information on specific dollar amounts.
Choosing TRICARE Prime
Those serving on active duty do not have a choice and must enroll in TRICARE Prime. All others may have the option to choose between Prime and Select.
Enrolling in TRICARE Prime
See the official TRICARE Prime Enrollment Page to learn more about signing up for TRICARE Prime.
TRICARE Select
TRICARE Select is a self-managed, preferred provider organization (PPO) plan. The TRICARE official site says this option is available in the United States for those registered in the Defense Enrollment Eligibility Reporting System or DEERS.
Select replaced TRICARE Standard and TRICARE Extra in 2018 with Select. TRICARE Select is a self-managed, preferred provider network plan featuring two options, TRICARE Select and TRICARE Select Overseas.
Read more: Ultimate TRICARE Guide
Who Qualifies For TRICARE Select
- Active duty family members
- Retired service members and their families
- Family members of those ordered to active duty service for more than 30 days in a row.
- Guard/Reserve members
- Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
- Retired Guard/Reserve members at age 60 and their families
- Surviving spouses and dependents
- Medal of Honor recipients and their families
- Qualified former spouses
How to Use TRICARE Select
To use TRICARE Select benefits, schedule an appointment with any TRICARE-authorized provider. Referrals are typically “not required for most primary and specialty appointments,” but pre-authorization from your regional contractor may be necessary “for some services,” according to TRICARE.
The TRICARE official site reminds, “You won’t receive a TRICARE wallet card when using TRICARE Select. All you need is your military ID as proof of coverage.”
Paying For TRICARE Select
TRICARE Select costs may vary based on the military member’s status. Costs include, but may not be limited to:
- An annual outpatient deductible
- Cost shares (or percentage) for covered services
- Enrollment fees for Group A retirees
Actual costs vary yearly; see the TRICARE official site for information on specific dollar amounts.
TRICARE Select or TRICARE PRIME?
Should you choose Select or Prime? The TRICARE official site states those on active duty, including members of the Guard and Reserve, cannot use TRICARE Select.
Otherwise, Select may be the right choice if you live in an area where Prime is unavailable or you have other health insurance coverage. TRICARE Select also a good choice for those with an out-of-network provider they don’t want to give up.
Read more: Ultimate TRICARE Guide