Choosing the Right Plan: TRICARE Prime or TRICARE Select
The TRICARE Open Season is an annual period when you can enroll in, change, or disenroll from a TRICARE health plan. In 2024, the open season runs from November 11 to December 10. Changes you make during the open season go into effect January 1, 2025. Whether you’re considering TRICARE Prime (including the US Family Health Plan) or TRICARE Select, it’s important to choose the plan that best fits your needs.
“Now is the perfect time to review your current plan and determine which is best for you and your family for 2021,” says Mark Ellis, chief of the Policy and Programs Section of the TRICARE Health Plan at the Defense Health Agency. “For example, if having a primary care manager (PCM) to oversee your care is a priority, TRICARE Prime might suit you. If flexibility in choosing specialists is more important, TRICARE Select could be a better fit.”
Active duty service members (ADSMs) are required to enroll in TRICARE Prime. However, active duty family members (ADFMs) can choose between TRICARE Prime and TRICARE Select. Here’s a breakdown of each plan to help you make an informed decision this open season.
TRICARE Prime: Coordinated Care with a PCM
TRICARE Prime is available in specific areas, known as Prime Service Areas. You can use the TRICARE Plan Finder to determine whether it’s an option in your location. TRICARE Prime typically involves using military hospitals and clinics, and requires that you select a PCM to manage your care. Your PCM will also provide referrals to specialists when necessary.
For ADFMs, retirees, or their family members, TRICARE Prime offers the option to see a specialist without a referral, but this is under the point-of-service option, which can increase out-of-pocket costs. If you stick to TRICARE network providers, your out-of-pocket expenses will usually be lower.
TRICARE Select: Greater Flexibility in Care
Unlike TRICARE Prime, TRICARE Select does not require a PCM. With TRICARE Select, you have the freedom to choose your own TRICARE-authorized providers and manage your healthcare independently. Generally, no referrals or pre-authorizations are needed. However, out-of-pocket costs will be higher if you opt for non-network providers, so using TRICARE network providers can help you save. Keep in mind, services from non-authorized providers won’t be reimbursed by TRICARE.
TRICARE Prime: Costs Overview
For ADSMs, ADFMs, and transitional survivors, TRICARE Prime has no enrollment fees. However, retirees and their families will need to pay annual enrollment fees.
ADFMs using network providers and obtaining the necessary referrals or pre-authorizations won’t have out-of-pocket costs for covered services. Retirees, on the other hand, will have copayments or cost-shares for services from network providers. All out-of-pocket expenses count towards your catastrophic cap, with the exception of costs incurred under the point-of-service option. TRICARE Prime also does not have a deductible.
TRICARE Select: Costs Overview
TRICARE Select generally involves higher out-of-pocket expenses compared to TRICARE Prime. While ADFMs don’t pay an annual enrollment fee, retirees and their families may need to pay enrollment fees depending on when the sponsor enlisted in the military. Starting next year, most Group A retirees and their families will need to pay enrollment fees for TRICARE Select. Make sure to set up automatic payments to avoid any lapse in coverage.
TRICARE Select also includes an annual deductible for covered services. Once the deductible is met, you’ll pay copayments or cost-shares per visit. Like TRICARE Prime, there’s a catastrophic cap to limit out-of-pocket expenses.
Compare Your Options
To make the best decision, use the tools available on the TRICARE website to compare plans and costs side by side. You can also search for providers through the Find a Doctor tool. Before making any changes to your plan, review the details of TRICARE Prime and TRICARE Select to ensure your healthcare needs are met during this open season.