What Is the Tricare Prime Health Plan?


Quick Answer

TRICARE Prime is a health plan for active-duty service members, retired service members, activated Guard and Reserve members, survivors and the families of these members, according to TRICARE. Eligible former spouses, Medal of Honor recipients and retired Guard and Reserve members also qualify for the health plan.

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Full Answer

Nonactivated Guard and Reserve members and their families can also participate in TRICARE Prime if they meet the Transitional Assistance Management Program criteria, states TRICARE. Retired service members who qualify for TRICARE For Life cannot apply for TRICARE Prime. Retired Reserve members, survivors and their families may opt to enroll in TRICARE Retired Reserve.

Eligible participants must live in Prime Service Areas and maintain minimum essential coverage to qualify for TRICARE Prime, notes TRICARE. Beneficiaries of the health plan receive care from an assigned primary care manager who work with regional contractors for referrals or authorization, refer the beneficiaries to specialists if necessary, accept copayments and file claims.

Qualifying individuals can enroll in TRICARE Prime by calling a regional contractor, mailing the application form to the regional contractor or applying online at the Beneficiary Web Enrollment website, says TRICARE. The health plan is available for free for active-duty service members and their families. However, active-duty family members who use the point-of-service option may pay a fee. Other beneficiaries make annual enrollment payments and network copayments.

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