Benefit Fact Sheet
TRICARE Prime is a managed-care health insurance option available to all eligible military beneficiaries that are not entitled to Medicare (are age 65 or older) in Prime Service Areas of the North, South, and West Regions of TRICARE.
DFAS will provide IRS Form 1095-C to all U.S. military members, and IRS Form 1095-B to all Retirees, Annuitants, former Spouses and all other individuals having TRICARE coverage during all or any portion of tax year 2022. An IRS Form 1095 documents you (and your Family members, if applicable) have the minimum essential coverage. These forms will document the information that DFAS will provide to the IRS on yourself and your authorized Family members. According to the IRS, these forms are not required to prepare or file income tax returns but will be available via myPay no later than January 31, 2023.
Army Reserve Soldiers are eligible for TRICARE Prime while on active duty and while on travel to and from home and duty station. Family members of Army Reserve Soldiers are eligible for TRICARE and may elect to utilize TRICARE Prime when:
The Reserve component Soldier is ordered to active duty for more than 30 consecutive days,
The Reserve component Soldier is medically retired due to service-connected injury, illness, or disease incurred or aggravated while on active duty,
The Reserve component Soldier completes 20 years of qualifying service, reaches age 60, and starts receiving retired pay, or
The Reserve component Soldier dies on active duty or as a result of a medical condition incurred or aggravated while on active duty.
Family members may choose TRICARE Prime, TRICARE Prime Remote or TRICARE Select.
Newborn babies and newly adopted Children are covered under Prime for the first 90 days (stateside) or 120 days (overseas). After 90 days (stateside) and 120 days (overseas) , they must be properly registered in Defense Enrollment Eligibility Reporting System (DEERS) and formally enrolled in Prime in order to receive Prime coverage.
TRICARE covers eligible Children until age 21. For TRICARE coverage beyond the age of 21, college students must be enrolled full-time at an accredited institution of higher education and the sponsor must provide more than 50 percent of the student's financial support up to the age of 23.
The National Defense Authorization Act (NDAA) FY 2011 gave the DoD the authority to expand benefits to qualified dependents that lose TRICARE eligibility and are under the age of 26. Young adults can purchase TRICARE Young Adult and pay monthly premiums.
Un-remarried former Spouses of eligible Soldiers may be eligible for Prime; however, the individual must first establish their eligibility for health care coverage by verifying registration in DEERS under their own social security number. Completing DD Form 2876 is required to enroll in TRICARE Prime under the former Spouse's SSN; otherwise, the former Spouse will be covered under TRICARE Select. The former Spouse must have been married to the same member or former member for at least 20 years, and at least 20 of those years must have been creditable in determining the member's eligibility for retirement pay with coverage beginning after the date of divorce, dissolution or annulment OR the former Spouse must have been married for at least 20 years, and at least 15 - but less than 20 - of those married years must have been creditable in determining the member's eligibility for retirement with coverage for only one year from the date of the divorce, dissolution, or annulment.
When an active duty sponsor dies, surviving Spouses remain eligible for TRICARE health care benefits as active duty Family members for a three-year period. At the end of the three-year period, TRICARE eligibility continues, but the survivor's status changes to that of retiree Family member. It is important for the survivor to update personal information and to keep supporting documents current in DEERS. Surviving Children whose sponsor died on or after October 7, 2001, remain eligible for TRICARE benefits. Unlike Spouses, eligibility will not change after three years, and Children remain covered until eligibility ends due to the age limits or another reason (e.g. marriage).
TRICARE Prime enrollees receive most of their health care at a military treatment facility (MTF) and their care is coordinated by a primary care manager (PCM). Prime enrollees agree to seek treatment first from their PCM (usually at the MTF) before seeking routine treatment elsewhere. ( Emergency care should be sought at the nearest emergency room or health care facility )
When a beneficiary enrolls in Prime at an MTF, they will be assigned a PCM who will coordinate care, maintain health records, and make referrals to specialists, if necessary. If specialty care is needed, or if the MTF cannot provide the treatment the beneficiary needs, the PCM may refer the patient to a "preferred" or "in-network" provider (doctor, nurse practitioner, lab, etc.) managed by the regional TRICARE contractor.
If you have TRICARE Prime, you must pay enrollment fees, unless you are:
An active duty Service member (including activated Guard/Reserve members)
An active duty Family member
A transitional survivor
Under age 65 with Medicare Parts A and B
All others pay annual enrollment fees and network copayments. The fee increase applies only to new enrollees whose TRICARE Prime applications are received on or after January 1, 2023.
If you are a survivor or medically-retired Service Member, your enrollment fee will stay the same as long as you keep TRICARE Prime.
Please visit https://tricare.mil/Costs/Compare to find your TRICARE costs, including copayments, enrollment fees, and payment options effective January 1, 2023.
MTF Appointment Priorities : Active duty Soldiers and Service members have first priority for making an appointment at the MTF. Next are active duty Family members who are enrolled in Prime, then all other Prime enrollees, followed by all other beneficiaries who are not enrolled in Prime.
TRICARE has access standards in place to help ensure timely health care. These include:
The wait time for an urgent care appointment should not exceed 24 hours (one day)
The wait time for routine appointment should not exceed one week (seven days)
The wait time for a specialty care appointment or wellness visit should not exceed four weeks (28 days)
The travel time for routine appointment should not exceed 30 minutes
The travel time for specialty care appointment should not exceed one hour.
TRICARE Prime Remote: TRICARE Prime is not available in all locations. Active duty Soldiers and their Families who are on remote assignment, typically 50 miles from an MTF, may utilize the TRICARE Prime Remote (TPR) program. TPR is specific to geographic location, and eligibility is based on residence and/or work address Zip Code. Eligibility for TPR requires that the Service member both live and work 50 miles from the nearest MTF or one hour's drive from the nearest MTF. To determine if a Soldier or Family member is eligible for TPR, enter the ZIP Codes in the following link:
TRICARE Overseas: TRICARE Prime is available for active duty and Families overseas. The TRICARE Overseas Program delivers the Prime benefit to active duty Soldiers and Families in the three overseas areas: Eurasia-Africa, the Pacific, and Latin America/Canada. The TRICARE Prime Remote Overseas program delivers the Prime benefit to active duty Soldiers and Families stationed in designated "remote" locations overseas. More information regarding the TRICARE Overseas Program may be found at:
Enrolling in Prime: For active duty Soldiers, Prime coverage is automatic, however the active duty Soldier must fill out an enrollment form and submit it to the regional TRICARE contractor. For active duty Family members who desire to participate in Prime, enrollment is required. One enrollment form must be submitted per person. Enrollment forms may be downloaded from the following TRICARE website: https://tricare.mil/Plans/Enroll/Prime.aspx
Alternatively, enrollment may be completed online via the Beneficiary Web Enrollment Web site: https://milconnect.dmdc.osd.mil/milconnect/
Disenrolling in Prime: Active duty Soldiers are required to be enrolled in Prime, however Family members may choose to disenroll from TRICARE Prime at any time. If they choose to disenroll before the annual enrollment renewal date, they may be subject to a one-year lockout. The lockout provision does not apply to Family members whose sponsor is E-1 through E-4.
Any change in status (e.g., from active duty to retired or a reservist demobilizing) will cause automatic disenrollment from TRICARE Prime. When the member changes status, and remains TRICARE eligible, he/she must re-enroll in Prime immediately to maintain coverage. Active duty Family members are required to disenroll from the TRICARE Overseas Program (TOP) Prime within 60 days of departure if they no longer live in a TOP Prime area.
Transferring Enrollment in Prime: Active duty Soldiers and Family members scheduled for a permanent change of station (PCS) move will remain enrolled in Prime for a maximum of 60 days from the date they leave their current TRICARE region (in the U.S. or overseas). To avoid Prime coverage interruptions, enrollees need to transfer their enrollment to the new regional contractor (U.S.) or MTF (overseas) and select a new PCM. Before the move, enrollees should let their current TRICARE Service Center (TSC) know they are moving. Upon arrival at the next duty station, enrollees should stop by a TSC in the new region or overseas area as soon as possible to fill out.
For more information, please visit the official TRICARE webpages maintained by the Office of the Assistant Secretary of Defense (Health Affairs) and the TRICARE Management Activity:
TRICARE Prime Home Page: https://tricare.mil/Plans/HealthPlans/Prime.aspx
TRICARE Home: https://tricare.mil/
TRICARE Regions: https://www.tricare.mil/About/Regions
TRICARE Region West: https://www.tricare-west.com/content/hnfs/home/tw.html
TRICARE Region East: https://www.humanamilitary.com/
TRICARE Overseas Region: http://www.tricare-overseas.com/
TRICARE DEERS Information: https://tricare.mil/DEERS
TRICARE Plans Overview: https://www.tricare.mil/-/media/Files/TRICARE/Publications/Misc/Plans_Overview.ashx