TRICARE Prime

Managed care option with assigned PCM and lowest costs.

TRICARE Prime is a managed care option similar to a civilian HMO (Health Maintenance Organization). It offers the most comprehensive coverage and lowest out-of-pocket costs in exchange for less flexibility in choosing providers.

Key features of TRICARE Prime: • Assigned Primary Care Manager (PCM) • Referrals required for specialty care • Enrollment in Prime Service Area (PSA) required • Lowest copays and cost-shares • No deductibles • Point-of-service option available (higher costs)

Who can enroll: • Active duty family members (ADFMs) • Retirees and their families • Must live in a Prime Service Area • Must enroll during eligible period

Costs (2024) • Active Duty Family: $0 enrollment fee • Retirees (Group A): $350 individual / $700 family annually • Civilian provider copays: $0-$34 depending on service and status • Most care at MTF or from assigned PCM: $0

Benefits of Prime: • Predictable, low costs • Coordinated care through PCM • Preventive care at no cost • Most comprehensive benefit package • Priority enrollment to MTFs

Limitations: • Must get referrals for specialists • Limited provider choice (assigned PCM) • Only available in PSAs • Must use network providers

Best for: Beneficiaries who want the lowest costs, don't mind assigned providers, prefer coordinated care, and live near a military installation or in a PSA with adequate network coverage.

TRICARE Prime requires more structure but delivers the most comprehensive care at the lowest cost, making it ideal for families with regular healthcare needs or those seeking maximum financial protection.