Disclaimer


Tricare Prime

Tricare Prime

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.

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45 comments

  1. If I am injured in an automobile accident by an uninsured motorist and do NOT carry Bodily Injury Uninsured Motorist Insurance, will TRICARE cover my medical expenses?

  2. How can I make an online appointment with my family practice provider?

  3. Im an active duty marine with 3rd Bn, 2nd Mar. My wife is enrolled into deers, im just trying to figure out how to access Tricare to see if she is covered. Thank you.

  4. Looking for something to cover the 20 percent my husband’s medicare does not cover. He is also a VA patient.

  5. What a terrible website! I have been searching relentlessly for the phone number for my regional provider and the links seem to navigate to the same few pages, over and over again! Please simplify this, because any changes that were done to this website were poorly done.

  6. I am currently enrolled in TRICARE Prime and would like to ensure my mailing address is current.

    Please advise and thanks in advance.

  7. I’m about to retire on September 30, 2015 and tried to call someone on what needs to completed for me to continue into Tricare Prime afterwards. Contact has been made once and was directed to look for forms but, having difficulty finding them on the site. I could not make contact for assistance in finding the form(s).

  8. why does it take over 30 days to get an appointment when on tricare prime. I am in fayetteville, Nc, and assigned to clark clinic and I can’t get an appointment until december. I have neck pain all the time and need surgery. why not be like the VA hospital? it seems you are

  9. What determines the reason for Tricare Prime only being in certain areas? We have a 6-year-old little girl with Aspergers (Autism spectrum) who needs ABA Therapy. Unfortunately, Tricare Standard is the only coverage we can get in the area where we live. Now we need to forfeit her services since we cannot afford to pay the difference. How often do the coverage areas change? I’d really hate to have to move somewhere because we can’t get our daughter’s services she so desperately needs.

  10. Chevelle Sizemore

    I am a spouse of an active duty member who is currently enrolled in TRICARE prime.
    My child and I are also enrolled. Do I (as a spouse) need to re enroll every year?

  11. So someone at Tricare did not send me my bill again. So I got removed from prime. I don’t want to go into the issues that I had with this company. My husband died active duty and I should be able to get prime!!!!! So I called yesterday and the customer service person told me to come to this website and I can print out a enrollment form. So can you please send that to me at my email address.
    Michelle Novak

  12. I am from Gravity Physical Therapy. I need a fax number for claims and/or benefits.

    Thank you

  13. Lorraine Johnson

    I need to change my billing information

  14. Dominique Agniel

    I wish to change my PCM because I feel like he is not doing his job to do hid job, instead he is doing it for the pay check. How do I go about that process

  15. Nofoaiga L Sualevai

    I am trying to enroll in the Prime Tricare Plan. I am a retired Navy Veteran, can you please provide me with the information on how to enroll. You need to clear your website on the many unnecessary information on it and provide the correct information under Plan your Tricare mode for us to make enrollment easy.

  16. Gerald S. Walker, Major U. S. Army retired

    What is Tricare for life and Tricare plus. The Ansbach health clinic will not support me (medically) because I am not registered as Tricare plus. However, when I talked to the Tricare representive I am not eligible for Tricare Plus as a retired service member. I have received excellent service from all military facilities in Germany except the Ansbach health clinic which refuses to provide medical care because I am not a Tricare plus member.

  17. do we have coverage in dermatology?, I’m in a tricare prime plan.

    • TRICARE covers dermatological services for the diagnosis and treatment of skin disorders, including:

      Medically-appropriate treatment for acne
      Photodynamic therapy
      Photochemotherapy

      Topical treatment for hypertropic scarring and keloids resulting from burns, surgical procedures or traumatic events may be covered only if there is evidence of impaired function.

      You can find more information here: http://www.tricare.mil/CoveredServices/IsItCovered/Dermatology

  18. I am a prime member with spouse, witch will be turning 65 . Will she be able to stay with prime instead of using Medicare.

  19. I am a spouse of a retiree. I am employed full time. I would like to have Tricare Prime as my primary insurance. How do I go about that?

  20. How much does Tricare Prime pay for out of network dental and vision visits? I am new to Tricare (marriage to a retiree) and want to keep the same dentist and eye doctor that I had under the Federal Employee Health Benefits (FEHB) Program.

  21. William J. Kweder Sr

    I served during the Vietnam War (13 years). When I separated from active duty I was given a disability of zero per cent. I have never tried to apply for any medical assistance from the VA. As a vet with a disability do I qualify for any aspect of Tricare? If so, what is my next step?

  22. I need a phone number for Tricare to check on a Referral to see a Gastrointestinal Doctor

  23. How am I able to see when my spouse became active on my insurance

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