Determining TRICARE Prime Availability and Selecting a Primary Care Manager
Determine if You Live in a Prime Service Area
Use the TRICARE Prime and PCM Selection Guide to determine if TRICARE Prime is available where you live within the access to care standards. If your state does not appear in the TRICARE Prime and PCM Selection Guide, your address is outside of the TRICARE West Region. However, you may still be eligible to select a PCM in the West Region if you find a PCM within 100 miles of your residential ZIP code. Otherwise, contact Humana Military if you are located in the TRICARE East Region.
Select a Primary Care Manager
The TRICARE Prime and PCM Selection Guide explains your PCM choices. You may be required to enroll with a PCM at your local military hospital or clinic. If you are not required to enroll with a military hospital or clinic, use the Network Provider Directory to find a civilian PCM.
Note: You and your PCM must be located within the same state.
If You Do Not Reside in a Prime Service Area
You may be able to enroll in a TRICARE Prime plan by waiving your drive time standards if you do not reside in a Prime Service Area. You must select a PCM in a Prime Service Area. Active duty service members and active duty family members may qualify for enrollment in TRICARE Prime Remote (TPR).
DETERMINE TRICARE PRIME REMOTE ELIGIBILITY
Active duty service members (ADSMs): ADSMs must live and work more than 50 miles or about one hour’s drive time from the nearest military hospital or clinic.
Active duty family members (ADFMs): ADFMs are eligible to enroll in TRICARE Prime Remote for Active Duty Family Members (TPRADFM) if they live with their TPR-enrolled sponsor.
- Exception: If the sponsor is enrolled in TRICARE Prime and the local military facility cannot accept family members due to patient capacity, TRICARE may allow family members to enroll in TPRADFM. TRICARE allows this exception anywhere within the United States. (Previously, it was limited to certain geographical areas.)
National Guard and Reserve family members: Family members of activated National Guard and Reserve members must live with the service member on the date the sponsor was called to active duty. Activated National Guard and Reserve members are not required to be enrolled in TPR for their family to enroll in TPRADFM.
View the TRICARE Plan Finder to determine eligibility for TPR.
If you are not eligible for TPRADFM, you may be able to waive your drive time standards or enroll in TRICARE Select.
Waive your drive time standards
You can waive the drive time standards and enroll in TRICARE Prime if:
- you do not live in a Prime Service Area and are not enrolled in TPRADFM; or
- you wish to have a PCM more than 30 minutes, but less than 100 miles from your residence address.
Note: Beneficiaries enrolled in TPRADFM must comply with drive time standards, but can have PCMs outside of a Prime Service Area.
It’s important to consider if your select PCM’s location might aggravate your health status or delay receiving timely medical treatment.
How to waive your drive time standards:
Note: A signed application includes those with a signature or an electronic signature.
If your enrollment application cannot be completed because the access waiver was not signed, you will be notified by mail of your alternate PCM assignment or the inability to process your request.
- If you choose to submit the access waiver in order for the original PCM request to be honored, the entire application must be resubmitted.
- The original effective date will be honored if the access waiver is received within 30 days of the original request.
Access to care tips – when a waiver is required:
- A new access waiver is required when adding a new family member to your existing enrollment policy.
- A new access waiver is required if your address or PCM changes.
- A new access waiver is not required if you request a PCM change within the same military hospital and clinic or civilian provider group at the same address.
- Drive time standards will be verified on all new enrollments, PCM changes and address changes based on door-to-door calculations (full residence address to military hospital and clinic or civilian PCM address) using the Network Provider Directory.
- You may not enroll in TRICARE Prime if you are more than 99.9 miles from a PCM in a Prime Service Area.