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Understanding TRICARE Prime

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TRICARE offers military families several health care plans that they can choose from. However, the plan that's most often used by active duty servicemembers and their dependents is TRICARE Prime.

The following information is provided to help you gain a better understanding of TRICARE Prime so that you can decide if this particular plan is the right one for you and your family.

About TRICARE Prime
This particular plan is similar to an HMO. Compared to the other plans that are offered, TRICARE Prime has the lowest out-of-pocket expenses. Unlike TRICARE Standard and Extra, enrollment is required to participate in Prime. What this means is that servicemembers and their dependents must fill out and submit the proper enrollment paperwork. (Instructions for doing this are listed below.)

Additionally, with TRICARE Prime you'll have a primary care manager and receive your care at a military treatment facility or other medical facility that's within with TRICARE network. For most types of specialty care you will need a referral from your primary care manager.

Enrollment Fees
There's no enrollment fees for active duty beneficiaries, to include active duty Reservists, Guardsmen, and their dependents.

Military personnel that are not on active duty are required to pay an enrollment fee and network copayments.

Enrollment fees may be paid annually, quarterly or monthly. The fees, which reflect the price increase that went into effect on October 1, 2011 are as follows:

  • Annual for Individuals: $260
  • Annual for Families: $520
  • Quarterly for Individuals: $65
  • Quarterly for Families: $130
  • Monthly for Individuals: $21.66
  • Monthly for Families: $43.33

Beneficiaries must live in a Prime Service Area that's within one of the TRICARE Regions. If you live outside of a Prime Service Area you may want to look into TRICARE Prime Remote, which is essentially the same kind of plan except beneficiaries can receive care from a TRICARE authorized provider if there are no TRICARE network providers in your area.

TRICARE Regions
TRICARE coverage areas within the continental United States are broken down into three regions: North, South, and West.

States covered in the North Region: Connecticut, Delaware, District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin, portions of Iowa, Missouri, and Tennessee.

States covered in the South Region: Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee (not the Ft. Campbell area which is part of the North Region) and Texas (not the El Paso area which is part of the West Region).

States covered in the West Region: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (not the Rock Island Arsenal area which is part of the North Region), Kansas, Minnesota, Missouri (not the St. Louis area which is part of the North Region), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas, Utah, Washington and Wyoming.

Enrolling in TRICARE Prime
Before you or your dependents can enroll in TRICARE Prime you must first be registered in the Defense Enrollment Eligibility Reporting System (DEERS). Once that's completed, you can then proceed to enrolling in TRICARE Prime if you decide it's the right plan for you.

For your convenience, TRICARE gives you three enrollment options:

Online. Go to the Beneficiary Web Enrollment Web site and follow the enrollment instructions. It's important to note that this option is only available to beneficiaries that are not required to pay enrollment fees.

By Mail. Select your region from the list below, download the form and mail it to the address that's provided in the document.

In Person. If, for whatever reason, you don't want to enroll via the Web site or through the mail, you're welcome to complete the form and drop it off at a TRICARE Service Center. To locate the center that's closest to you, please select your region:

Additional Information
If you have questions or want to learn more about TRICARE Prime, please download the TRICARE Prime handbook or visit the TRICARE Prime Web site.

Further information about TRICARE Prime Remote is featured in the TRICARE Prime Remote downloadable handbook, courtesy of TRICARE.

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