Back to Benefits & Deals

Step-by-step guide to Tricare Prime for retirees

Cost-saving plan for retirees and their dependents

Recommend Article
Total Recommendations (0)
Clip Article Email Article Print Article Share Article

I met Col. Michelle Nassar soon after her retirement from the Army. When our discussion turned to health insurance, she expressed concern. After 20 years of receiving health care at military treatment facilities with no out-of-pocket expenses, figuring out how to use TRICARE Prime in the civilian marketplace and the idea of paying for it can be daunting. However, once you learn the process and some important terms, this well-earned benefit can be as simple as following a battle plan.

TRICARE Prime is available to retirees and their dependents living in areas around military treatment facilities and former base realignment and closure sites. It meets the minimum essential coverage requirements under the Affordable Care Act.

Your TRICARE Prime enrollment application must be received no later than the last day of your active duty orders to avoid a lapse in coverage. Family members must be registered in DEERS and have been enrolled with TRICARE Prime on your last day of active duty orders to receive continuous coverage as well. If this requirement isn't met, applications received on or before the 20th of the month are effective the first day of the next month. Enrollment can be done online at under "Enroll or Purchase a Plan," which supplies a link to the Beneficiary Web Enrollment Website. The annual enrollment fee for FY 2014 is $273.84 for individuals and $547.68 for families. When you consider the average civilian pays as much monthly for insurance premiums, this cost may be less troubling.

The next step is to choose a primary care manager, or PCM, from the provider network in your region. Network providers are physicians who've signed a contract to accept TRICARE negotiated rates and file your claims. Like on active duty, your PCM is your first point of contact for your health care needs. There is a $12 copayment for each visit to the PCM. When you need care your PCM can't provide, he will give you a referral to a network specialist and obtain authorization from TRICARE. Visits to specialists who are network providers also incur a $12 copayment. If you choose a physician outside of the network, the point-of-service fee structure takes effect. Point-of-service fees are incurred when you see a non-network provider in lieu of your regular copayment. They are usually much more expensive because non-network providers aren't bound to TRICARE negotiated rates. To keep your out-of-pocket costs down, it's best to see only network providers.

Coverage for emergency care, vision, and prescription drugs differs slightly for retirees. Visits to an emergency room don't require prior authorization from TRICARE when there's a potential for loss of life, limb or sight. However, care must be sought at a hospital-based emergency facility that's open 24 hours a day, and you must contact your PCM within 24 hours or the next business day after receiving emergency care. Vision coverage consists of one routine examination every 24 months with a network optometrist or ophthalmologist. If more frequent care is necessary, you must obtain a referral from your PCM and TRICARE authorization. Network pharmacies can be found on and provide authorized prescription drugs at the following costs for a 30-day supply: $5 for generic; $15 for brand name; and $44 for non-formulary.

If you have questions about coverage, it's always best to contact TRICARE at 800.444.5445 before seeking care.

With this information in hand, TRICARE Prime is a cost-saving benefit that allows you to enjoy retirement without worries.

"I had my first doctor's appointment as a retiree this week. It was an easier process than I thought it would be," Nassar said.

comments powered by Disqus

Site Search