What Is Tricare Prime?
Tricare Prime is the managed care health plan for members of the U.S. military and their family members. Enrollees are guaranteed health care anywhere a military health care facility operates and can access benefits even when outside the United States through specialized subplans such as Tricare Prime Overseas. The plan features low co-payments and deductibles, and it maintains a large network of civilian health care providers.
Eligibility
Active duty members of all branches of the U.S. military enroll in Tricare Prime. Dependents of sailors, soldiers, marines and Air Force personnel can also enroll, as can active and retired members of the National Guard and their dependents, retired military personnel and their dependents, and spouses and dependants of military personnel killed in action. A dependent is a spouse, minor child, college student younger than 22 years and someone who relies on the military or National Guard member or veteran for their housing and care.
Subplans
Military personnel and other Tricare enrollees who live in the United States but more than 50 miles from the nearest military base can sign up for Prime Remote. A second subplan, Prime Overseas, provides health coverage for deployed military personnel and dependents who live on or near a military base. Tricare Remote Overseas is open to individuals deployed outside the United States and far away from U.S. bases, Tricare Reserve Select specifically covers National Guard members and their dependents, and the US Family Health plan provides coverage for special patient populations such as retirees.
Coverage
When you enroll with Tricare Prime, you chose a primary care manager. This physician fills the role of a general practitioner or internal medicine specialist, and he will be the person you see most often when seeking medical care. Enrollees can receive medical, dental, vision and prescription drug coverage through Tricare Prime.
Co-pays and Deductibles
The amount Tricare Prime enrollees pay for doctor's appointments and medical procedures depends on the rank or grade and service status of the principal person on the policy. That is, an Army corporal will pay less than an Army colonel when cost-sharing is required, and the co-pay for surgery for a child of a chief petty officer will be lower than the co-pay for surgery for a child of a commander. Similarly, out-of-pocket payments for prescriptions will depend on who the principal plan member is and also on whether a particular medication is on Tricare's formulary prescribed by brand name or prescribed by generic name.
Accessing Care
Through Tricare Prime, you will receive most of your covered medical care at on-base clinics and hospitals---institutions Tricare dubs "military treatment facilities." Should you need care military health care providers cannot deliver, you will get a referral to a civilian provider. Enrollees who do not live near military treatment facilities will have a civilian physician serve as the primary care provider.
Tags: Tricare Prime, health care, National Guard, their dependents, United States, care providers, co-pay surgery