This step will help you decide whether to enroll in a TRICARE Prime option or to use TRICARE
Standard and TRICARE Extra. TRICARE For Life (TFL), TRICARE’s wraparound coverage for
Medicare-eligible beneficiaries, is also described in this section.
TRICARE Prime vs. TRICARE Standard and TRICARE Extra Figure 3.1
TRICARE Prime
TRICARE Standard
TRICARE Extra
Type of Program
Managed Care
Fee-for-service
Preferred provider
Enrollment
Enrollment is required.
Active duty service members(ADSMs) and active duty family members (ADFMs) do
not pay enrollment fees. All other eligible beneficiaries pay enrollment fees.
Enrollment is not required
Enrollment is not required
Providers
Receive most of their care from a primary care manager (PCM) at military treatment facilities MTFs) or from TRICARE network providers. Priority access to care at MTFs.
Receive care from TRICARE-authorized non-network providers.MTF care on a space-available basis only.
Receive care from TRICARE-
authorized non-network
providers.MTF care on a space-available basis only.
Cost of
Care
Offers fewer out-of-pocket costs than TRICARE Standard and TRICARE Extra.Pay nothing for care at MTF (in most cases).
Pay annual deductibles and cost-shares.
Higher costs than TRICARE Prime or TRICARE Extra.
Pay annual deductibles and discounted cost-shares. Higher costs than TRICARE
Prime, but lower than TRICARE
Standard.
Claims
Providers will file claims for you (in most cases).
Providers may choose to file claims for you or you will have to file your own claims.
Providers will file claims for you (in most cases).
Program Availability
In most cases, available in TRICARE Prime service areas (PSAs).
Available worldwide.
Available within the Continental United States; not available overseas.
Additional Details
ADSMs and their family members who do not live in a TRICARE PSA may be eligible for TRICARE Prime Remote (TPR) or TRICARE Prime Remote for Active Duty Family Members (TPRADFM). Beneficiaries (except ADSMs) may seek nonemergency care without a referral through the point of service (POS) option, but will pay higher out-of-pocket costs when using this option.
The program is available for
beneficiaries (except ADSMs) who choose not to enroll in TRICARE Prime.The provider or the beneficiary must file a medical claim before TRICARE Standard will pay its portion of the bill. If the beneficiary files the claim, the payment is then mailed to the beneficiary who must reimburse the provider. If the provider files the claim, he or she will be reimbursed byTRICARE.
The program is available for
beneficiaries (except ADSMs)
who choose not to enroll in
TRICARE Prime.
