Contents
Overview
TRICARE Prime is a managed-care option: you have a primary care manager (PCM) who coordinates your care, you need a referral for almost every specialist, and you pay the lowest out-of-pocket costs. TRICARE Select is a self-managed option: no PCM, no referrals required for most care, you can see any TRICARE-authorized provider — but you pay more per visit and an annual deductible.
Quick decision rule: If you live near a military hospital/clinic, want predictable low costs, and don't mind referrals → choose Prime. If you want flexibility to choose any TRICARE-authorized provider without referrals → choose Select. Active duty service members do not have a choice — they must enroll in Prime.
📋 Who It's For
Active duty service members: must enroll in Prime (no choice). Active duty family members, retirees under 65, Guard/Reserve activated members and families: can choose Prime or Select during Open Season or after a Qualifying Life Event. Both plans require: enrollment in DEERS (Defense Enrollment Eligibility Reporting System) and an active uniformed services ID card. Geography matters for Prime: you must live in a Prime Service Area; otherwise consider TRICARE Prime Remote or Select.
💰 Costs (2025)
TRICARE Prime — 2025 retiree costs:
| | Group A | Group B | |---|---|---| | Annual enrollment fee | $372 / $744 | $450 / $900.96 | | Primary care visit | $25 | $25 | | Specialty visit | $38 | $38 | | ER visit | $77 | $77 | | Annual deductible | None | None |
TRICARE Select — 2025 retiree costs (in-network):
| | Group A | Group B | |---|---|---| | Annual enrollment fee | $0 | $579 / $1,158.96 | | Annual deductible | $150 / $300 | $193 / $386 | | Primary care visit | $37 | $32 | | Specialty visit | $51 | $51 | | ER visit | $140 | $103 | | Inpatient admission | $250/day or 25% | $225 per admission |
Active duty family members pay $0 under both Prime and Select for in-network care.
2025 catastrophic caps (max out-of-pocket, excluding premiums): Group A retirees $4,989; Group B retirees $4,989; ADFMs much lower.
🩺 What's Covered
Coverage is essentially identical. Both Prime and Select cover the same medically necessary services: preventive care, primary care, specialty care, hospitalization, mental health and substance use treatment, maternity care, and most surgeries. Prescription drugs are covered separately under the TRICARE pharmacy benefit (Express Scripts), regardless of whether you choose Prime or Select. The difference between the plans is how you access care and what you pay — not what is covered.
📝 How to Enroll or Use
Choose Prime when: - You live in a Prime Service Area near a military hospital or clinic. - You're OK letting a PCM coordinate your care. - You want the lowest predictable costs. - You're an active duty service member (mandatory).
Choose Select when: - You want freedom to see any TRICARE-authorized provider without referrals. - You already have established relationships with civilian specialists you don't want to lose. - You travel often or live in an area without strong Prime network coverage.
Switching plans: You can change between Prime and Select during the annual TRICARE Open Season (typically mid-November to mid-December) or after a Qualifying Life Event (marriage, birth, retirement, move, etc.). Use milConnect or call your regional contractor.
⚠️ Common Pitfalls
1. Picking Prime, then ignoring referral rules. Seeing a specialist without your PCM's referral triggers the Point-of-Service option — 50% cost-share plus a $300/$600 deductible. Those costs don't count toward your cap. 2. Picking Select, then forgetting the deductible. Many beneficiaries are surprised when their first visit of the year costs full price until the deductible is met. 3. Choosing Select to keep one specific doctor. Confirm that doctor accepts TRICARE — being in your network under prior insurance doesn't mean they'll bill TRICARE. 4. Letting your DEERS information go stale. Both plans depend on accurate DEERS records — wrong address or dependent status will deny claims. 5. Missing Open Season. Outside of a QLE, you can only switch plans during Open Season. Miss it and you're locked in for a year.
❓ Frequently Asked
Can I switch from Prime to Select mid-year? Only after a Qualifying Life Event (marriage, birth, retirement, move, loss of other coverage, etc.). Otherwise wait for Open Season.
Do both plans use the same network? Both use the TRICARE network of authorized providers. Prime requires you to stay in network and use referrals; Select lets you see any TRICARE-authorized provider, in or out of network (out-of-network costs more).
Are pharmacy benefits different? No. Both Prime and Select use the same TRICARE pharmacy benefit administered by Express Scripts, with the same formulary and same costs.
What about overseas? Prime is available as TRICARE Prime Overseas; Select is available as TRICARE Select Overseas. Cost rules are similar to stateside but with overseas-specific networks.
🔄 Recent Changes
Jan. 1, 2018: TRICARE Standard and Extra were merged into TRICARE Select. The Group A / Group B beneficiary distinction was created. Jan. 1, 2025: TriWest Healthcare Alliance replaced Health Net Federal Services as the West Region T-5 contractor. Beneficiaries in the 26 West Region states use TriWest for referrals, claims, and enrollment. Humana Military continues in the East Region. 2025 fees: Modest increases to Prime enrollment fees, Select cost-shares, and catastrophic caps based on the National Health Expenditure Accounts index.
📚 Official Sources
- TRICARE Plans Comparison: https://tricare.mil/Plans/ComparePlans
- 2025 Costs and Fees Sheet: https://tricare.mil/Costs
- Federal Register CY2025 cost notice: https://www.govinfo.gov/content/pkg/FR-2024-11-06/html/2024-25753.htm
- Beneficiary Groups: https://tricare.mil/Costs/AllCosts/Groups
- East Region (Humana Military): https://www.humanamilitary.com
- West Region (TriWest): https://www.tricare-west.com
Key Facts
- Category
- culture
- Type
- concept
- Format
- guide
Frequently Asked Questions
Which plan has lower out-of-pocket costs?
TRICARE Prime — by a wide margin. Prime has no annual deductible and lower per-visit copays. Select adds an annual deductible plus higher copays in exchange for letting you see any TRICARE-authorized provider without a referral.
Can I keep the same doctor if I switch from Select to Prime?
Only if your doctor is willing and able to be your assigned PCM, or if your doctor is in the TRICARE network and your PCM refers you to them. Many beneficiaries lose their preferred specialist when switching to Prime.
Do active duty family members pay anything under either plan?
ADFMs pay $0 for in-network care under both Prime and Select. They have no enrollment fee under Prime and no deductible under Select for in-network services.
What's the catastrophic cap and why does it matter?
It's the maximum you and your family pay out of pocket per calendar year for covered care, including enrollment fees and copays but excluding premiums. Once you hit the cap, TRICARE pays 100% of covered services for the rest of the year. In 2025 the cap is $4,989 for retirees in both Group A and Group B.