TRICARE and You – Prime vs. standard enrollment

This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.

Written by Petty Officer 1st Class Nicole Flores

tricare orangeWhether you are new to the Coast Guard or a seasoned vet, the difference between TRICARE Prime and TRICARE Standard can be a bit confusing, and trying to decide which plan is right your family can be a bit overwhelming. If you are struggling with which plan to choose, here are some points to consider.

Prime vs. Standard Enrollment:

TRICARE Prime is the Health Maintenance Organization (HMO) health care plan that covers all uniformed service members. Active-duty service members, are automatically covered by TRICARE Prime; but, you must fill out and turn in an enrollment form that records your Prime coverage to your regional contractor. Active-duty family members may choose to enroll in Prime and are assigned a primary care manager, or PCM. There are no enrollment fees, deductibles or co-payments for active-duty family members. Under TRICARE Prime, specialty care must be referred by the PCM and will managed by the TRICARE contractor. Family members who choose not to enroll in Prime are covered under Standard. Under Standard, a PCM is not assigned and PCM referrals for specialty care are not required, but this plan accrues more out of pocket expenses. Retirees and retiree family members and survivors (under age 65) may also choose to enroll in Prime; however, they will pay an enrollment fee and small co-pays. If they choose not to enroll in Prime, they are covered under Standard.

Prime vs. Standard Care:

This chart compares the two programs:

Prime vs. Standard

TRICARE Prime Remote:

If you live in an area where TRICARE has determined military treatment facilities (MTFs) are not available and/or access to medical care is more restricted, members and their dependents may be enrolled in TRICARE Prime Remote. TRICARE Prime Remote functions much like TRICARE Prime in terms of reduced costs, no deductible, and claims being filed for you. Depending on availability, a PCM may or may not be assigned by TRICARE. If not, any TRICARE authorized provider may be seen even if they aren’t in the network, at no additional cost.

FAQs:

Q: If I’m enrolled in TRICARE Prime and I don’t see a military doctor at a MTF, how do I find a civilian doctor that’s in the network?
A: You can visit the TRICARE website to find a networked doctor.

Q: TRICARE Prime Remote sounds great. Can I choose that option if I want it?
A: Your unit must be designated as eligible for TRICARE Prime Remote. You can search your unit by zip code to see if you’re eligible.

Q: At what age are my children no longer covered by TRICARE?
A: Regular TRICARE coverage ends at 21 for dependent children, or 23 if enrolled in college. After that you may purchase TRICARE Young Adult at an added cost.

If you are still struggling with trying to decide which TRICARE plan is right for you, or you have any questions regarding your TRICARE benefit, please visit the TRICARE website or contact the CG HSWL Service Center’s health benefits advice line at 1-800-9HBA-HBA. We have beneficiary counseling and assistance coordinators standing by to assist you.

Do you have other questions about the TRICARE benefit? Leave a comment below, and we will work to get your questions answered!

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