Having your military benefits squared away is a priority. But, it can also be a confusing process to complete. There are a lot of steps to finish, and when you tackle TRICARE, you might come out wondering which way is up. With more than one program available, how do you know which TRICARE is right for you?
Every active duty service member has to enroll in TRICARE Prime. Some have the option to choose TRICARE Select. But, what is the difference and who gets to choose?
TRICARE Prime is a managed care coverage option. This is similar to an HMO. It includes care at military hospitals and clinics and authorized network providers. TRICARE Prime holders are assigned a primary care manager (PCM) who provides most of their care. PCMs provide referrals to specialist and files claims for you when needed.
Active duty members pay nothing out-of-pocket for TRICARE Prime. Active duty family members also pay nothing unless using the Point-of-Service Option. With this option, family members may visit other TRICARE providers, but stipulations apply.
TRICARE Prime is only available in certain stateside areas and overseas. Other TRICARE Prime options include:
TRICARE Select (formerly known as TRICARE Standard, is a self-managed plan) like a preferred provider organization or PPO. It provides you freedom to choose your TRICARE-authorized provider and location worldwide. TRICARE Select is available to:
Referrals are not needed for most primary or specialty care visits. You will not receive an insurance card to carry but you military ID serves as proof of coverage. This also serves as additional coverage when you have employer health coverage.
If you are active duty, you don’t get to choose. You have to enroll in TRICARE Prime. If you have the option to choose TRICARE Select, you have more flexibility in choosing your providers, but you also have more out-of-pocket expenses. Staying with TRICARE-authorized providers can help decrease the costs.
TRICARE Prime provides you a PCM who will treat you and file your claims. You won’t have this with TRICARE Prime, you may or may not need to file your own claims.
TRICARE Prime requires referrals from your PCM. TRICARE Select does not, though may not be accepted by the specialist or you may have to pay upfront and file a claim for reimbursement. If you choose a provider who is not in network, you will not be reimbursed.
TRICARE Prime has limited coverage areas both in the U.S. and overseas. TRICARE Select does not.
TRICARE Prime has lower out-of-pocket fees when used in network. TRICARE Select has higher out-of-pocket fees and can result in higher billing. While active duty family members have no yearly fees, retirees and their families, and others do pay yearly fees.
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Brandy Hall, Nurse Writer, turned a passion for patient teaching into content writing. She teams up with podcasters and health care providers to improve health understanding. Now she explores the world through creativity and adventure as a mom and military spouse.