Differences In Coverage Based on Beneficiary Program Option
Coverage for clinical preventive services varies, depending on whether a beneficiary is using TRICARE Prime, TRICARE Standard, or TRICARE Extra.
With TRICARE Prime:
- TRICARE Prime offers enhanced vision coverage. (See “Vision Care” later in this section for more details.)
- TRICARE Prime enrollees do not need a referral or prior authorization for clinical preventive services.*
- There is no copayment when care is received from a TRICARE network provider.
* ADSMs must have a referral and prior authorization before receiving clinical preventive services, except for those enrolled in TPR when care is rendered by their PCM.
When using TRICARE Standard or TRICARE Extra:
- Preventive vision coverage is not included after age 6. (See “Vision Care” later in this section for details.)
- Beneficiaries using TRICARE Standard or TRICARE Extra may have clinical preventive services performed by a TRICARE-authorized network or non-network provider.
- Cost-shares and deductibles apply.
For more information about clinical preventive services that TRICARE covers, access Chapter 7, Sections 2.1–2.2 of the TRICARE Policy Manual. |
