This article outlines a few key features of the TRICARE Prime plan, such as who is eligible for that and how that health care plan works.
TRICARE Prime health care plans are available in certain areas across the world. In order to determine whether you are eligible for receiving TRICARE Prime coverage, you can use your ZIP code to see if the area you reside in is a Prime Service Area. In order to access the benefits that are offered by this plan, you are required to enroll for the program. The benefits that are provided under the TRICARE Prime health care plan are those that meet the minimum coverage requirement, in accordance with the Affordable Care Act.
TRICARE Prime is available to active members of the military forces and members of their family, retired members of the military and members of their family, members of the National Guard and Reserve who have been activated plus their families, retired members of the National Guard and Reserve and their family members, recipients of the Medal of Honor and family members of recipients, and any survivors and ex-spouses (if they qualify for accessing these benefits).
Under the TRICARE Prime health care plan, a primary care manager will be assigned to you as soon as you enroll for it. This will be either a network provider or a military provider. The primary care manager will be responsible for providing you with all your basic, primary care. In case you need to see a specialist, the primary care manager will be the one responsible for referring you to a specialist and providing you with the referral that you need (together with each individual’s regional contractor). In addition to this, the primary care manager will manage most of the basic health care; the primary care manager is responsible for making appointments with the doctor on your behalf and will also maintain a health record for each individual. Furthermore, the primary care manager will also accept any co-payments for you. In addition to this, under the TRICARE Primary health care plan, you do not need to worry about filing and making claims for reimbursement, because this will also be managed by the primary care manager.
The TRICARE Primary health care plan is one of the most cost effective and affordable health care plans. This is because if you are currently an actively serving member of the military forces, you do not need to pay anything out of your own pocket. If you have also enrolled any of your family members for the same health care plan, then they do not need to pay anything either unless they make use of a point-of-service option. Any other beneficiaries who are considered eligible for the TRICARE Prime health care option are required to pay a fee for enrollment, and may also need to pay network co-payments.
All actively serving members of the military forces are automatically enrolled in the TRICARE Prime health care plan. Other individuals can choose to register for this health care option, or avail the TRICARE Standard or TRICARE Extra options. Although TRICARE Prime is cheaper, it also provides less choice as far as service providers are concerned.