TRICARE Prime Coverage Details

FILE - Staff Sgt. Rebekah Crawford gets her ear canal examined using an Otto Scope. (USAF photo: Senior Airman Christopher Toon)
FILE - Staff Sgt. Rebekah Crawford gets her ear canal examined using an Otto Scope. (USAF photo: Senior Airman Christopher Toon)

TRICARE Prime is a health insurance program offered to active duty members, retirees, activated guard & reserve members, and families. If you're on active duty, you have to enroll in TRICARE Prime, all others can choose to enroll or use TRICARE Standard and Extra. TRICARE Prime offers fewer out-of-pocket costs than TRICARE Standard and Extra, but less freedom of choice for providers.

There are four TRICARE Prime Plans:

  1. TRICARE Prime
  2. TRICARE Prime Remote
  3. TRICARE Prime Overseas
  4. TRICARE Prime Remote Overseas

Each plan is generally the same, differing only in the geographical area that it covers.

TRICARE categories

There are two separate categories of TRICARE beneficiaries:

  1. Group A: where the servicemember entered active duty before 2018
  2. Group B: where the servicemember entered active duty in 2018 or later

tricare prime for families of Active Duty members 

Family members of active duty personnel will pay:

  • Minimal out-of-pocket-costs
  • No enrollment fees
  • No network copayments
  • No point-of-service fees unless using the point-of-service option

tricare prime for families of retirees

All other people using TRICARE Prime will pay an annual enrollment fee of $289.08 for a single member and $578.16 for a family for those in group A, and $350 for a single member and $700.00 for a family for those in group B.

catastropic cap 

The catastrophic cap is the maximum amount you will pay out-of-pocket annually for all healthcare. The catastrophic cap resets each year.

Active duty recipients  have a catastrophic cap of $1,000. Retired recipients have a catastrophic cap of $3,000 for Group A or $3,500 for Group B.

Copay amounts

In addition to an enrollment fee, you also may pay a copayment for various services received at network providers, these fees are: 

TRICARE Prime Copayments

Service Active Duty Cost Retiree Cost 
Annual Deductible $0 $0
Primary Care $0 $20
Specialist $0 $30
Urgent Care $0 $30
Emergency Room $0 $60
Hospital $0 $150
Outpatient Services $0 $60
Ambulance $0 $40
Medical Equipment $0 20%
Maternity $0 $150*

*For retirees the copay for maternity services varies according to location of services performed.

For more details, visit the TRICARE website. 

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