TRICARE Prime or TRICARE Select: How to Decide

FALLS CHURCH, Va. – Are you thinking about your health care options for 2023? TRICARE Open Season, which runs until Dec. 13, might be your only chance all year to make changes to your current health coverage or enroll in a TRICARE Prime option, including the US Family Health Plan, or TRICARE Select.

“TRICARE Prime and TRICARE Select are different health plans that reflect the different needs of TRICARE beneficiaries,” said Shane Pham, program analyst with TRICARE Health Plan’s Policy and Programs Section at the Defense Health Agency. “Open season is the time to choose the health plan that best suits your family’s needs for the coming year.”

Not everyone has a choice of plans. Active duty service members (ADSMs) must enroll in TRICARE Prime, as described in the TRICARE Plans Overview Fact Sheet. However, active duty family members (ADFMs) may have a choice between TRICARE Prime and TRICARE Select. What are the most important factors to consider? Below are key differences between the two plans, to help you compare.

TRICARE Prime
TRICARE Prime is available in certain stateside areas, called Prime Service Areas. Depending on where you live and your sponsor’s status, other TRICARE Prime options include:

TRICARE Prime Remote, an option for ADSMs and their family members who live and work in remote locations (outside of a Prime Service Area)
US Family Health Plan, an option where care is provided by not-for-profit health care systems in six areas of the United States
TRICARE Prime Overseas and TRICARE Prime Remote Overseas, are options available to ADSMs and their command-sponsored family members in overseas locations

You can search TRICARE plans to see if TRICARE Prime is an option where you live.

Getting care with TRICARE Prime
TRICARE Prime is your managed care option. It offers the most affordable coverage. How do you receive care under TRICARE Prime?

You usually receive care from military hospitals and clinics.
You’re required to have a primary care manager (PCM) who will manage your care.
You must have a referral from your provider to see a specialist. When you need referrals or pre-authorizations, your PCM will work with your TRICARE regional contractor.
If you’re an ADFM, retiree, or retiree family member, you can see a specialist without a referral under the point-of-service option. This will result in higher out-of-pocket costs.
Your provider will file a claim for you in most cases.

Out-of-pocket costs with TRICARE Prime
In general, TRICARE Prime has lower out-of-pocket costs than TRICARE Select. What costs can you expect?

ADSMs, ADFMs, and transitional survivors have no enrollment costs. Retirees, their families, and others pay yearly enrollment fees.
ADSMs don’t pay out-of-pockets costs.
ADFMs don’t pay out-of-pocket costs for TRICARE covered services if they see a TRICARE-authorized network provider in their 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.
There’s no annual deductible.

TRICARE Select
Those eligible for TRICARE Select include:

ADFMs
Retirees
Retiree family members

ADSMs can’t enroll in TRICARE Select. In overseas locations, TRICARE Select Overseas is available.

Getting care with TRICARE Select
TRICARE Select is a self-managed care option. TRICARE Select offers the most freedom of choice.

There’s no required PCM.
You manage your own health care and can receive care from any TRICARE-authorized provider. However, you’ll pay higher out-of-pocket costs when you receive care outside the established network of providers. Non-participating non-network providers may charge up to 15% above the TRICARE-allowable amount.
If you need specialty care, referrals and pre-authorizations aren’t required in most situations.
If you get care from a non-network provider, you may have to pay for services up front and file your own claims for reimbursement.
You may get care at military hospitals or clinics if space is available.

Out-of-pocket costs with TRICARE Select
TRICARE Select has the following out-of-pocket costs:

ADFMs have no yearly enrollment fees.
Retirees, their families, and others have enrollment fees based on when you or your military sponsor initially joined the military.
There’s 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.

Learn more about TRICARE Prime and TRICARE Select. Take advantage of the compare plans and compare costs tools when making your decision for coverage next year. Remember, open season ends Dec. 13.

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