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News | Nov. 25, 2020

What Plan is Right for You, TRICARE Prime or TRICARE Select?

By TRICARE Communications

The annual TRICARE Open Season is underway until Dec. 14. This is your chance to make changes to your current health coverage or enroll in a new TRICARE Prime (including the US Family Health Plan) or TRICARE Select plan. But do you know which plan best meets your needs?

“Now is the time to look at your current plans and consider which are best for you and your family in 2021,” said Mark Ellis, chief of the Policy and Programs Section of the TRICARE Health Plan with the Defense Health Agency. “For example, if you want a primary care manager to coordinate your care, TRICARE Prime might be right for you. If you would prefer more flexibility when picking specialty providers, consider TRICARE Select.”

Active duty service members (ADSMs) must enroll in TRICARE Prime, but eligible active duty family members (ADFMs) may have a choice between TRICARE Prime and TRICARE Select. To learn more about the differences between your open season health plan options, here’s a closer look at them.

Getting Care with TRICARE Prime

TRICARE Prime is only available in certain stateside areas, called Prime Service Areas. You can use the TRICARE Plan Finder to see if TRICARE Prime is an option where you live. As described in the TRICARE Plans Overview, TRICARE Prime generally features the use of military hospitals and clinics. You’re required to have a primary care manager (PCM) who will manage your care and refer you to specialists for care, when needed. If you’re an ADFM, retiree, or retiree family member, you can also see a specialist without a referral under the point-of-service option. If you use TRICARE network providers, your per visit or service out-of-pocket costs will generally be less.

Getting Care with TRICARE Select

With TRICARE Select, you aren’t required to have a PCM. You can choose your own TRICARE-authorized provider and manage your own health care. In most situations, you don’t need a referral or pre-authorization from your provider. You’ll have higher out-of-pocket costs if you use a TRICARE-authorized non-network provider instead of a TRICARE-authorized network provider. In other words, you can save money with TRICARE Select if you see a network provider. If you choose a TRICARE non-authorized, non-network provider, you won’t be reimbursed by TRICARE.

TRICARE Prime Costs

If you’re an ADSM, ADFM, or transitional survivor, you don’t pay enrollment fees with TRICARE Prime. Retirees, their families, and others pay annual enrollment fees.

ADFMs won’t pay out-of-pocket costs for TRICARE covered services if you see a TRICARE network provider in your region, and with the appropriate referral or pre-authorization. Retirees pay copayments or cost-shares for covered health care services from network providers. When following the rule of your plan, out-of-pocket costs are limited to your catastrophic cap. Costs you pay under the point-of-service option don’t apply toward your catastrophic cap. There’s no deductible with TRICARE Prime.

TRICARE Select Costs

In general, TRICARE Select has higher out-of-pocket costs than TRICARE Prime. With TRICARE Select, ADFMs don’t pay an annual enrollment fee. Retirees, their families, and others may have enrollment fees based on when you or your sponsor joined the military. Starting next year, most Group A retirees and their family members enrolled in TRICARE Select will have enrollment fees. You need to set up your automatic payments now to avoid break in coverage.

There’s also an annual deductible for TRICARE covered services. After the deductible is met, you pay per-visit copayments or cost-shares. Your out-of-pocket costs are limited to your catastrophic cap.

To help you weigh the options outlined above, you can also compare plans and compare costs side-by-side on the TRICARE website. In addition, you can use Find a Doctor and check provider directories. Before enrolling or making a change to your plan, learn more about TRICARE Prime and TRICARE Select to help you take command of your health this open season.

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