What is TRICARE Prime?
Quick Answer
TRICARE Prime is a managed care plan with a primary care manager, low copays, and referral-based specialty care. It is the lowest-cost TRICARE option available in Prime Service Areas.
Detailed Answer
TRICARE Prime is a managed care option similar to a civilian Health Maintenance Organization (HMO) that provides comprehensive healthcare coverage with the lowest out-of-pocket costs among TRICARE plans. Beneficiaries enrolled in Prime are assigned or choose a primary care manager (PCM) who coordinates all their healthcare needs and provides referrals for specialty care. TRICARE Prime is available in designated Prime Service Areas (PSAs), which are areas with adequate military and civilian provider networks. Active duty service members are automatically enrolled in Prime at no cost, while active duty family members can enroll at no enrollment fee. Retirees and their families pay annual enrollment fees ($350 individual, $700 family for 2024). Prime emphasizes preventive care and wellness, with most preventive services covered at no cost. The trade-off for lower costs is less flexibility in choosing providers, as beneficiaries must use their PCM and obtain referrals for specialists.
Related TRICARE Terms
TRICARE Prime
Managed care option with assigned PCM and lowest costs.
Primary Care Manager(PCM)
Your main doctor who coordinates your healthcare.
Prime Service Area(PSA)
Geographic area where TRICARE Prime is available.
Referral
Authorization from your PCM to see a specialist.
Copayment
Fixed amount you pay for covered services.
Related Questions
What is the difference between TRICARE Prime and TRICARE Select?
TRICARE Prime is a managed care option with a primary care manager and lower costs. TRICARE Select offers more flexibility to choose providers with higher out-of-pocket expenses.
What is TRICARE Select?
TRICARE Select is a self-managed preferred provider plan similar to a PPO that offers more flexibility in choosing providers without referrals, but with higher out-of-pocket costs.