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TRICARE Prime Enrollment – Retirees and Their Family Members

Overview

TRICARE Prime is a managed care option similar to a civilian health maintenance organization (HMO). It is available in areas around military hospitals and clinics and former base realignment and closure (BRAC) sites.

Beneficiaries enrolled in TRICARE Prime have an assigned primary care manager and may require a prior authorization and/or referral for specialty care.

Eligibility

Those eligible for TRICARE Prime include:

In addition, beneficiaries must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) and must choose a PCM where TRICARE Prime is offered.

Please refer to our Determining TRICARE Prime Availability page to determine if you reside in a Prime Service Area.

Enrolling in TRICARE Prime

You may enroll by:

Note: Be sure to include a three-month payment with your enrollment application.

Beneficiaries who remain eligible will be automatically re-enrolled each year unless they elect a different option or disenroll during the open enrollment season.

Changes in enrollment can only be made during the open enrollment season or within 90 days of a qualifying life event (see below). Visit our TRICARE Open Season page to learn more. 

Split Enrollment

Members of the same family may be enrolled in TRICARE Prime in different regions. Only one region will bill for the entire family enrollment. Individual and family enrollment fees for TRICARE Prime are separate from individual and family enrollment fees for TRICARE Select. The sponsor's enrollment determines which region receives the payment.

  • The region where the sponsor is enrolled is the lead contractor and will bill for the entire family.
  • If the sponsor is not enrolled, the region with the oldest enrolled family member is the lead contractor and will bill for the entire family.

Everyone on the account will be disenrolled for non-payment if payment is not received. 

Make sure to update your split enrollment information with each family member's regional contractor.

Effective Dates

If you enroll in TRICARE Prime during TRICARE's Open Season, your enrollment is effective January 1 of the following year. Enrollment due to a qualifying life event (QLE), such as adding a newborn, is effective the date of the QLE.  

Fees

Retired service members and their family members have an annual enrollment fee for TRICARE Prime. The first quarterly payment is due with the enrollment application. 

A beneficiary’s group category is determined by the sponsor’s initial enlistment or appointment date:

  • • Group A: Sponsor’s enlistment or appointment date occurred prior to Jan. 1, 2018.
  • • Group B: Sponsor’s enlistment or appointment date occurred on or after Jan. 1, 2018.

Enrollment fees are subject to change each calendar year (Jan. 1–Dec. 31) except for Group A beneficiaries who are classified as a survivor of an active duty service member or for medically-retired members and their dependents. 

Type of Coverage Group A Group B
Member Only 2018: $289.08
2019: $297.00
2018: $350.00
2019: $360.00
Member and Family 2018: $578.16
2019: $594.00
2018: $700.00
2019: $720.00

 

Review Make a Payment and Payment Options for future payment information.

Failure to pay the total amount due will result in disenrollment from TRICARE Prime. Your disenrollment will be effective the day following your policy paid-through date. Once disenrolled from TRICARE Prime, you will be only eligible for coverage at the military hospital/clinic under direct care if space is available. Claims for services after your disenrollment date will not be paid under your TRICARE Prime coverage. 

Primary Care Managers

There are three steps to choosing or changing your primary care manager (PCM). Visit our PCM page to learn more.

Qualifying Life Events (QLEs)

Visit our Qualifying Life Events page for detailed information.

Disenrolling from TRICARE Prime

Voluntary disenrollment: You may voluntarily disenroll from TRICARE Prime. However, eligible beneficiaries not enrolled in a TRICARE plan are only covered for care at the military hospital or clinic under direct care if space is available. Beneficiaries can only re-enroll during the open enrollment season and/or in the event of a QLE.

You may disenroll by:

If voluntarily disenrolling, you can request a specific disenrollment date. Otherwise, the disenrollment will be effective the day after your paid-through date.

Non-payment: If HNFS does not receive your premium payment within 30 days from the due date, you will be disenrolled for failure to pay. If you are disenrolled for failure to pay, you will be suspended from TRICARE Prime effective your paid-through date and any claims for services after your suspension date will not be paid under your TRICARE Prime coverage. 

Reinstatement

If you have been disenrolled for failure to pay for less than 90 days, you may be reinstated. Full payment is required to bring the policy current. If disenrolled greater than 90 days, you will be eligible for enrollment at the next open enrollment season or when a QLE occurs.