Active duty service members are automatically enrolled in TRICARE Prime, the military’s managed care plan. You pay nothing out of pocket for your health coverage, with no premiums, no deductibles, and no copays. Your family members have a few more options, but your own plan is straightforward.
TRICARE Prime Is Your Required Plan
Every active duty service member is enrolled in TRICARE Prime. You don’t choose between plans the way retirees or reservists do. Your primary care manager (PCM) is assigned at your military hospital or clinic, and that PCM coordinates all of your medical care. There is zero cost to you for any covered service.
If you need to see a specialist or get care outside your military treatment facility, your PCM handles the referral process. Your provider works with your regional contractor to get both a referral and a pre-authorization at the same time. Once approved, you receive an authorization letter through your region’s patient portal with instructions on where to go and how to schedule. You must book with the provider listed in that letter and complete your care before the authorization expires, or you’ll need to get it reapproved.
In some cases, the Military Medical Support Office may review your referral and redirect your care back to a military facility if they determine it can be treated there. You can also request specialty care at a military hospital or clinic yourself, as long as your commander agrees.
Coverage When You Live Far From a Base
If you live and work more than 50 miles, or more than one hour’s drive, from a military hospital or clinic, you’re eligible for TRICARE Prime Remote. This version of Prime works the same way in terms of cost (still zero), but your PCM will be a civilian provider in the TRICARE network rather than a military one.
The referral process shifts slightly when you’re remote. Your civilian PCM sends specialty referrals to your regional contractor, who reviews them based on your eligibility, medical necessity, and whether TRICARE covers the service. Approval typically means continued civilian care near your location.
Overseas Assignments
When you’re stationed outside the United States, your coverage transfers to either TRICARE Prime Overseas or TRICARE Prime Remote Overseas, depending on your proximity to a military medical facility. International SOS is the regional contractor for all overseas areas and manages your care coordination.
You have 90 days from your address change to transfer your coverage. The best move is to call International SOS as soon as you know you’re relocating. Your enrollment transfer takes effect the day you speak with the new contractor and agree to the transfer. Even if it takes up to four business days to fully process, you’re covered by International SOS in the interim.
Dental Care for Active Duty
Your dental coverage runs through the Active Duty Dental Program (ADDP), which is separate from your medical plan. The contractor that administers it is United Concordia.
How you access dental care depends on your location. If you’re assigned to a stateside military dental clinic, that clinic determines whether you need care from a civilian dentist. If they refer you out, they start the referral and tell you how to schedule. If you’re in a remote location stateside, you can self-refer for routine dental care, but you need an appointment control number (ACN) from United Concordia before seeing a civilian dentist. Overseas remote members should contact United Concordia first. They’ll verify your eligibility, issue your ACN, and coordinate scheduling.
Vision Coverage
TRICARE covers routine eye exams for active duty service members as needed to maintain fitness for duty. There’s no strict frequency limit the way there is for family members or retirees. If you need glasses, you’ll get a prescription during your exam. Contact lenses require a separate fitting exam.
What Your Family Members Can Choose
While you’re locked into TRICARE Prime, your dependents have options. They can enroll in TRICARE Prime for the managed care approach with a PCM and referrals, or they can choose TRICARE Select, which works more like a traditional insurance plan with the freedom to see any TRICARE-authorized provider without referrals.
Family members on Prime pay nothing for most care unless they use the point-of-service option, which lets them see providers outside the network at a higher cost. TRICARE Select generally involves annual deductibles and cost shares but offers more flexibility in choosing doctors. Overseas, dependents have parallel options: TRICARE Prime Overseas, Prime Remote Overseas, or Select Overseas. Young adult dependents (ages 21 to 26, or 23 to 26 if in college) can also enroll in TRICARE Young Adult under either a Prime or Select option, though that plan has its own premiums.
Urgent and Emergency Care
You can go to any emergency room for a genuine emergency without a referral. For urgent care, you still technically need a referral, but the practical reality is that your PCM works with your regional contractor to authorize it. If you’re remote or traveling and can’t reach your PCM, contact your regional contractor for guidance on where to go.
The key thing to remember as an active duty member is that your coverage is comprehensive and costs you nothing, but it does require you to work through the referral system for anything beyond your PCM. Skipping that step, especially for specialty or non-emergency care, can create paperwork headaches even though you won’t face a bill.