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:
Each plan is generally the same, differing only in the geographical area that it covers.
There are two separate categories of TRICARE beneficiaries:
- Group A: where the servicemember entered active duty before 2018
- 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.
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.
In addition to an enrollment fee, you also may pay a copayment for various services received at network providers, these fees are:
|Service||Active Duty Cost||Retiree Cost|
*For retirees the copay for maternity services varies according to location of services performed.
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