TRICARE Prime Healthcare Benefits and Eligibility

If you have answered the call to service and joined the military community in any capacity, the military ensures you and your family some valuable benefits. Among them, healthcare coverage is the most important. To draw maximum benefits of health coverage, it becomes necessary to be aware of your rightful claim.

Health care coverage falls under three primary care plans of the US military health system, popularly known as TRICARE. Among the three, TRICARE Prime is the most popular choice as it is both comprehensive and affordable.

What is TRICARE Prime?

TRICARE Prime is the lowest cost health care option for service members (both in active duty and those retired) and their families. It calls upon fewer out of pocket costs than any other TRICARE options available.

For the enrolees of TRICARE Prime, most of their health care comes from Military Treatment Facilities (MTF’s), which consists of military hospitals and outpatients’ clinics located on military bases and post around the world.

Each Primary enrolee either selects or is assigned a primary care manager (PCM) responsible for their routine and urgent healthcare needs and all paperwork that goes along with it.

Advantages of TRICARE Prime

• Active duty members and their families do not require an enrolment fee
• The enrolment fee is affordable for retirees and their families
• Enrolees are exempted from consultation fees at Military Treatment Facilities
• Active duty members have access to authorized civilian providers for free
• Availability of primary care manager for supervising and coordinating care
• Enrolees can receive services without referral or authorization

Limitations of TRICARE Prime

• It is not available in all geographic regions
• There is a limited choice of providers that fall under TRICARE Prime
• In the case of specialty care, referrals are required.

Who is Eligible?

Active-duty personnel are automatically the enrollees of TRICARE Prime. In contrast, their family members need to enroll individually to TRICARE Prime by filling out a form if they choose to join it. Other than them, retired officers and activated Guard/Reserve members and their respective families also can enroll in TRICARE Prime.

Bridging the Distance Gap

Those people who do not live in Prime Service Areas can opt from the following TRICARE Prime Plans that are designed specifically for the geographically distanced enrolees:

1. TRICARE Prime Remote- the enrolees may or may not have access to a PCM depending on availability but can reach out to a TRICARE authorized caregiver
2. TRICARE Prime Overseas- the enrollees, have access to assigned PCM at the nearest Military Treatment Facility. For accessing non-military facilities abroad, they can reach out to TRICARE overseas offices for assistance.
3. TRICARE Prime Remote Overseas- the enrolees can contact regional call centers to schedule referrals or appointments.