TRICARE Prime

TRICARE Prime is one of the plans that TRICARE offers.  All active duty servicemen's families are eligible for this plan.  There is no enrollment fee; however, a form must be completed in order for Prime to be their coverage plan.

• TRICARE PRIME ENROLLMENT FORM

One thing that should not be confused is just because you have enrolled in TRICARE Prime and it is military affiliated, it does not mean that you will be assigned a doctor on base.  TRICARE has contracted with Civilian Medical Providers called Preferred Provider Network (PPN) that you could be assigned to. 

• Your Primary Care Manager (PCM) will always see you first with your health care 
• Your PCM will provide your care
• PCM will keep and maintain your health records
• Also, if necessary your PCM will refer you to a specialist

Point-of-Service (POS) Option allows people who are enrolled in TRICARE Prime the freedom to find and recieve health care services from any TRICARE authorized civilian provider, without requesting a referral from their PCM.

• More info on POS

Advantages to choosing TRICARE Prime:

• No enrollment fee for active duty and their family
• No fee for active duty members when seeing your civilian provider
• There is no balance billing
• You are guantareed appointments with your provider
• It is guaranteed that your PCM will coordinate and supervise your care
• There is an option to have away-from-home emergency care
• Point-of-Service option

Disadvantages to choosing TRICARE Prime:

• There is an enrollment fee for retirees and their families
• Your PCM is limited
• You are only allowed to have speciality care by referral
• Not universally available

Military Spouse Medical Benefits

• There are different types of  TRICARE Plans that are designed to benefit military spouse's.  Depending on which plan you choose, it may be completely free.  This is a huge benefit that the military offers and you should definitely take advantage of it.
• TRICARE Prime is the most popular TRICARE plan.  All active duty members and their families are eligible for this without any enrollment fees.

TRICARE Plans

All current military spouses are entitiled to Free Medical Benefits through TRICARE. Most people agree that TRICARE is the most confusing benefit that is offered from the military.  As you can see, there are three different TRICARE plans and the table below will give you a short description of each and in the next few blogs I will further explain them.

Eligible Active Duty, Guard and Reserve Family Members:

	TRICARE Prime	TRICARE Extra	TRICARE Standard
Annual Deductible	None	$150/individual or $300/family for E-5 & above; $50/$100 for E-4 & below	$150/individual or $300/family for E-5 & above; $50/100 E-4 below
Annual Enrollment Fee	None	None	None
Civilian Outpatient Visit	No Cost	15% of negotiated fee	20% of allowed charges for covered service
Civilian Inpatient Admission	No Cost	Greater of $25 or $14.35/day	Greater of $25 or $14.35/day
Civilian Inpatient Behavioral Health	No Cost	Greater of $20 per day or $25 per admission	Greater of $20 per day or $25 per admission
Civilian Inpatient Skilled Nursing Facility Care	$0 per diem charge per admission	$11/day ($25 minimum) Charge per admission	$11/day ($25 minimum) Charge per admission
	No separate co-payment/cost-share for separately billed professional charges