TRICARE Prime versus TRICARE Select: Should you change or keep your plan?
Take Command of Your Health
TRICARE Open Season is from Nov. 12 through Dec. 10, 2018. This is the annual period when you can enroll in or change your TRICARE Prime or TRICARE Select plan. If you miss open season, you’ll only be able to make enrollment changes within 90 days of a Qualifying Life Event or during the next TRICARE Open Season in fall 2019. If you don’t want to change your plan, you don’t need to do anything during TRICARE Open Season.
To help you pick the program that’s right for you during TRICARE Open Season, here’s an overview of the differences between TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime and TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider. Enrollment is required to participate. TRICARE Select.
TRICARE Prime: A Managed Care Plan
TRICARE Prime is a managed care option, similar to a health maintenance organization program, which offers affordable and comprehensive health care coverage. You will be assigned a provider who is your primary care manager (PCM). Your PCM will:
- Manage your health care
- Provide your routine health care
- Get any referrals or authorizations you need
- Refer you to a specialist when you need it
- File your medical claims
Active duty service members (ADSMs) must enroll in TRICARE Prime. Active duty family members (ADFMs) may choose to enroll in TRICARE Prime or TRICARE Select. There are a few TRICARE Prime plans available, including: TRICARE Prime, TRICARE Prime RemoteA managed care option for active duty service members and their families who live in designated remote locations in the U.S. (usually more than 50 miles or one hour's drive time from a military hospital or clinic).TRICARE Prime Remote, TRICARE Prime OverseasA managed care option for active duty service members and command-sponsored family members in overseas areas near military hospitals and clinics.TRICARE Prime Overseas, TRICARE Prime Remote OverseasA managed care option for active duty service members and command-sponsored family members in designated remote overseas locations.TRICARE Prime Remote Overseas and TRICARE Young AdultA premium-based plan for qualified adult children.TRICARE Young Adult-Prime.
- TRICARE Prime for eligible beneficiaries that live in or near a Prime Service Area (PSA) in the U.S.
- TRICARE Prime Remote for eligible ADFMs who live outside of a PSA
- TRICARE Overseas Program Prime and TRICARE Overseas Program Prime Remote for ADSMs and their command-sponsored family members living overseas
- US Family Health Plan for beneficiaries who live in one of six areas in the U.S. where it’s offered
TRICARE Select: A Preferred Provider Plan
TRICARE Select is a self-managed, preferred provider option. You manage your own health care without a PCM and choose which TRICARE-authorized providers you see. You don’t need referrals, but your regional contractor must authorize some services. Network providers will file claims for you. You may have to file your own claims if you get non-network care. For help with filing claims, visit the Filing Claims page.
You may enroll in TRICARE Select anywhere in the U.S. if you aren’t an active duty service member. If you live overseas, you may enroll in TRICARE Overseas Program Select.
TRICARE Prime Costs
There are no out-of-pocket costs if you’re an ADSM. And there are no costs if you’re an ADFM, unless you use the point-of-service option. All other beneficiaries pay:
- An annual enrollment fee
- Copayments
For more information, visit the TRICARE Costs page.
TRICARE Select Costs
When you receive care within the TRICARE network, you have fewer costs if you use TRICARE Select. When you use TRICARE Select, you can expect to pay:
- An annual enrollment fee (for certain beneficiaries)
- An annual deductible
- A fixed fee for some outpatient services
- A cost-share (a part of the total cost of each service you receive)
For more information, visit the TRICARE Costs page.
What Do I Need to Do During Open Season?
There are a few things you need to do during open season if you want to change your plan.
- Make sure your information is up to date in the Defense Enrollment Eligibility Reporting System.
- Compare TRICARE Prime and TRICARE Select using the Compare Plans tool.
- If you want to enroll in TRICARE Prime or TRICARE Select, you can enroll online, by mail, or by phone.
For more information about TRICARE Open Season, visit the Open Season page on the TRICARE website. Find more about TRICARE Prime and TRICARE Select under Health Plans. Take command of your benefit this fall, and make any changes to your TRICARE health coverage before TRICARE Open Season ends on Dec. 10, 2018.
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