Eligibility for TRICARE Prime

Besides on-duty servicemen, the following people are also eligible to take advantage of TRICARE Prime: Living relatives and family members

Besides on-duty servicemen, the following people are also eligible to take advantage of TRICARE Prime:

  • Living relatives and family members of on-duty servicemen
  • Retirees and their living family members under the age of 65 years old
  • Guard and Reserve servicemen who are activated for more than a month and their family members

Remember: Retired military servicemen who reside more than 40 miles away from a military treatment facility are not supported by TRICARE Prime any more.

On-Duty Servicemen

The maximum amount you need to pay personally is $1,000 in a fiscal year. When your family is not registered under TRICARE Prime, the amount deducted each year depends on your salary. Until E-4, this amount is $100 per family or $50 per family member. For E-5 and above scales, it is $300 per family or $150 per family member. No fee is charged annually, unless you choose the point of service care option.

Usually, having TRICARE Prime coverage allows you and your family to receive assistance from nurses, doctor’s assistants, and even doctors in the military treatment facility (MTF). In case your Primary Care Manager (PCM) or main health care provider is in your locality (50 mile radius from your residence and workplace) is not associated with a MTF, you can register within the TRICARE Prime Remote program and visit a nearby general TRICARE-approved Primary Care Manager.

Get Benefits

A TRICARE Prime beneficiary must always consult his or her Primary Care Manager (at a local MTF) before going to a specialist or utilizing other medical facilities.

The cost of co-payment amounts and the Point of Service yearly charges are not added to the registration yearly maximum personal expenses. Rather, it is credited to the fiscal year maximum amount. The amount of patient’s liability, under Point of Service plan is endless.

The first person to contact with your all types of medical matters is your PCM, who takes care of your treatment and keeps all records. In case you need to visit a specialist within or outside the TRICARE Prime coverage network, your Primary Care Manager is going to give a reference and arrange an appointment. This can also be done through a TRICARE nurse, known as a health care finder.

You can choose to utilize only a single Point of Service under your TRICARE Prime coverage. POS allows you to consult any general health care provider, irrespective of the TRICARE network, without having a reference from a Primary Care Manager. Note that Point of Service requests can be expensive.  You need to pay patient charges ($600 per family or $300 per member yearly), 50% of outpatient and inpatient charges, as well as an extra charge of up to 15% of the permissible amount.

Tricare Admin

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