To keep things somewhat simple, we are just going to talk about TRICARE for active duty and dependents. There are two forms of TRICARE: Prime and Standard. Put simply, TRICARE Prime means you are assigned a primary care manager (PCM) at a specific hospital, typically the base hospital or a clinic off base. Standard means you can choose your own doctor.
Active duty members must use Prime if they are in a Prime service area. Dependents, however, can choose either. TRICARE Prime offers fewer out-of-pocket expenses than TRICARE Standard but less freedom of choice for providers.
Today's Military Mondays post is going to be all about the wonderful world of TRICARE Prime.
A few notes before we get started:
This information is specific to active duty dependents. Costs/details/enrollment will differ from the information below for retirees, reservists, etc.
Dental is handled separately. There is no such thing as Prime/Standard for dental coverage, and I will talk about that in a different post.
People usually have a strong opinion one way or the other on Prime vs. Standard. I was on Prime for 3 years and then switched to Standard when I got pregnant 2 years ago. There are pros and cons to both, but I'm going to leave my opinions out of it and just go with the facts. Feel free to email me if you have any questions about my personal experience with either Prime or Standard. :)
Enrolling in TRICARE Prime
Click here to enroll in TRICARE Prime.
Military hospitals and clinics can be both on and off base and are called MTFs (Military Treatment Facilities). Once you click the above link to enroll in TRICARE Prime, you need to select your MTF. Click here to enter your zip code and choose a MTF. In my case, a mixture of base hospitals and off-base clinics pop up as options.
Once you pick your MTF, you may enroll in TRICARE Prime either online, by phone, or snail mail. This is nice, yall. When I enrolled 5 years ago, I had to do it in person on base. You can find the instructions on how to do each here.
Your part is now done. You will be notified once your enrollment has been processed. You will then receive your PCM's name and phone number and instructions on how to download your enrollment card. Once enrolled, you may begin seeing your PCM immediately.
How It Works
Your PCM is just that, your primary care manager. Once you enroll in TRICARE Prime, you have to see your PCM first. They will assess your health care needs and refer you to specialty doctors if necessary. For specialty care to be covered, it must be arranged and approved by your PCM. For example, if you are struggling with infertility, your PCM must recommend fertility specialists and treatment. Your PCM also maintains your health records and files your claims with TRICARE. You must go through your PCM before you receive any care or treatment.
If you do not like your PCM, you may request to switch. As long as your requested PCM is accepting new patients, you will be switched in up to 6 business days.
What You Will Have To Pay For
Short answer: nothing.
Dependents don't have to pay for anything, so long as you go through your PCM and he/she approves any care/treatment. Appointments, procedures, surgeries, childbirth, prescriptions, x-rays... all free!
Currently, you must receive a referral to see any doctor besides your PCM. However, starting May 23rd, TRICARE Prime users will be allowed to use in-network urgent care providers without receiving authorization from the PCM. Eligible Prime members will be given 2 free visits per year to urgent care facilities without the pre-approval of your PCM. You can read more about this here.
I hope this post has been informative for any new or soon-to-be military spouses! In the coming weeks, we will talk about the complicated phenomenon that is TRICARE Standard. If you have any questions about my experience with Prime or anything else, feel free to comment below or shoot me an email.