TRICARE Prime vs Select: How To Decide
TRICARE Prime vs Select
Trying to decide between TRICARE Prime vs Select? This is a question a lot of military families face. There is always plenty of discussions each winter during the Tricare Open Season concerning the differences between TRICARE Prime vs Select. Here’s the breakdown.
TRICARE Open Season
“TRICARE Open Season is the annual period when you can enroll in or change your TRICARE Prime or TRICARE Select plan. It occurs each fall, beginning on the Monday of the second full week in November to the Monday of the second full week in December. If you miss Open Season, you’ll only be able to make enrollment changes within 90 days of a Qualifying Life Event or during the next TRICARE Open Season. If you don’t want to change your plan, you don’t need to do anything during TRICARE Open Season.”
TRICARE Prime Overview
Active duty service members must enroll in TRICARE Prime. Active duty family members may choose to enroll in TRICARE Prime or TRICARE Select.
There are a few TRICARE Prime plans available:
- TRICARE Prime for eligible beneficiaries that live in or near a Prime Service Area (PSA) in the U.S.
- TRICARE Prime Remote for eligible ADFMs who live outside of a PSA
- TRICARE Overseas Program Prime and TRICARE Overseas Program Prime Remote for ADSMs and their command-sponsored family members living overseas
- US Family Health Plan for beneficiaries who live in one of six areas in the U.S. where it’s offered
TRICARE Prime is a managed care option, similar to a health maintenance organization (HMO) program, which offers affordable and comprehensive health care coverage. You will be assigned a provider who is your primary care manager (PCM). Your PCM will:
- Manage your health care
- Provide your routine health care
- Get any referrals or authorizations you need
- Refer you to a specialist when you need it
- File your medical claims
TRICARE Prime Pros:
- With TRICARE Prime there are no out-of-pocket costs if you’re an active duty service member. Additionally, there are no costs if you’re an active duty family member, unless you use the point-of-service option.
TRICARE Prime Cons:
- With TRICARE Prime, you are assigned a primary care manager (PCM) who will manage your health. You do not get to choose your provider.
- You must have a referral from your PCM in order to see a specialist. That specialist must also be in the TRICARE Prime Network.
TRICARE Select is a self-managed, preferred provider option. You manage your own health care without a PCM and choose which TRICARE-authorized providers you see. You don’t need referrals, but your regional contractor must authorize some services. Network providers will file claims for you. You may have to file your own claims if you get non-network care. For help with filing claims, visit the Filing Claims page.
You may enroll in TRICARE Select anywhere in the U.S. if you aren’t an active duty service member. If you live overseas, you may enroll in TRICARE Overseas Program Select.
Tricare Select now has two groups. Group A is for those who entered military service before January 1, 2018, and their family members and Group B is for those who entered after January 1st, 2018, and their family members.
TRICARE Select Pros:
- Select doesn’t require a referral to specialists
- You have the freedom to choose your doctor and have consistency with that same doctor.
- You’ll pay less for care received from network providers, but you’re not required to use network providers.
TRICARE Select Cons:
When you use TRICARE Select, you can expect to pay:
- An annual enrollment fee: Active duty and their family members do not have to pay an enrollment fee. Family members of Group A will need to pay $150 annually for an individual or $300 for a family as of 2021. For family members of veterans and retirees in Group B, there will be a $474 fee for individuals and $948 for family.
- An annual deductible: Group A’s fees for an E1-E4 would be $50 per individual and $100 per family. For E5 & above the fees would be $150 per individual and $300 per family. Retirees would pay $150 per individual and $300 per family. For active duty family members, Group B’s fees for an E1-E4 would be $52 per individual and $105 per family. For E5 & above they would be $156 per individual and $300 per family. Retirees would pay $158 per individual and $317 per family.
- A fixed fee for some outpatient services
- A cost-share (a part of the total cost of each service you receive)
- Once you reach your deductible a copay kicks in, but each family is capped at $1,000 per year out of pocket for active duty Group A, $1,058 for Active Duty Group B, $3,500 for retired Group A, and $3,703 for retired Group B.
Still Interested In Switching?
Here’s what you need to do during TRICARE Open Season:
- Make sure your information is up to date in the Defense Enrollment Eligibility Reporting System.
- Compare TRICARE Prime and TRICARE Select using the Compare Plans tool.
- If you want to enroll in TRICARE Prime or TRICARE Select, you can enroll online, by mail, or by phone.
- What TRICARE Covers
- TRICARE: Guide to TRICARE
- Military Benefits Changes for 2020
- TRICARE Adds New Coverage For Babies
- TRICARE to Cover 3D Breast Cancer Screenings in 2020
- New TRICARE Select Fees for Retirees