Understanding TRICARE Prime and TRICARE Select: Navigating Your Military Health Care Options
If you’re a military service member, veteran, or a dependent, one of your most valuable benefits is your access to TRICARE, the Department of Defense’s health care program. Two primary options under this program are TRICARE Prime and TRICARE Select. Understanding these options can help you get the most out of your benefits. This post will delve into the specifics of each, their costs, and how they work, helping you make an informed choice.
TRICARE Prime is a managed care health option, similar to a civilian HMO. It offers comprehensive health care coverage, and you usually have no out-of-pocket costs for care, as long as you receive care from within the TRICARE Prime network.
Costs: While TRICARE Prime typically has lower out-of-pocket costs, you may need to pay an enrollment fee, depending on your beneficiary category. Detailed cost information is available on the TRICARE Prime Costs page.
Network: With TRICARE Prime, you will have an assigned primary care manager (PCM) who provides most of your care and can refer you to specialists if needed. Usually, your PCM is a military provider at a Military Treatment Facility (MTF), but you can also choose a civilian PCM within the TRICARE network. If you need care that your PCM cannot provide, you must have a referral to another TRICARE provider.
Availability: TRICARE Prime is available in Prime Service Areas, which are generally areas within 40 miles of a Military Treatment Facility. If you live outside of a Prime Service Area, you may be eligible for TRICARE Prime Remote.
On the other hand, TRICARE Select is a self-managed, preferred provider health plan, similar to a civilian PPO. With TRICARE Select, you have more flexibility in choosing your providers but also potentially higher costs.
Costs: TRICARE Select typically has higher out-of-pocket costs than TRICARE Prime. Depending on your beneficiary category, you may have to pay an enrollment fee, and you will also have copayments for services. For detailed cost information, refer to the TRICARE Select Costs page.
Network: TRICARE Select allows more flexibility in choosing your health care providers. You can visit any TRICARE-authorized provider, network, or non-network. While you do not need referrals for most services, seeing network providers can save you money.
Availability: TRICARE Select is available worldwide to eligible beneficiaries.
Making Your Decision
To decide between TRICARE Prime and TRICARE Select, consider the following factors:
- Location: Are you in a Prime Service Area? Are the network providers conveniently located for you?
- Flexibility: Do you prefer the flexibility of choosing your providers, or are you comfortable with assigned care from a PCM?
- Costs: Can you afford the potential out-of-pocket costs of TRICARE Select, or would the generally lower costs of TRICARE Prime better suit your budget?
- Health Needs: Do you have specialized health care needs that require seeing specific providers?
Use the TRICARE Compare Plans tool to evaluate your options based on your specific situation.
Remember, your health care coverage is a valuable benefit. Understanding TRICARE Prime and TRICARE Select can help you make the most of it. If you have any questions, don’t hesitate to reach out to a TRICARE representative for assistance.