Tricare Prime is a health insurance program offered to active-duty members, retirees, activated Guard and reserve members, and families. If you're on active duty, you have to enroll in Tricare Prime. All others can choose to enroll in Tricare Select. Tricare Prime offers fewer out-of-pocket costs than Tricare Select but less freedom to choose providers.
There are four Tricare Prime plans:
Each plan is generally the same, differing only in the geographical area that it covers.
Tricare Groups
The two groups of Tricare beneficiaries include:
- Group A: The service member entered active duty before 2018.
- Group B: The service member entered active duty in 2018 or later.
Tricare Prime for Families of Active-Duty Members
Family members of active-duty personnel will pay:
- Minimal out-of-pocket costs
- No enrollment fees
- No network copayments
- No point-of-service fees unless using the point-of-service option
Tricare Prime for Families of Retirees
Retirees using Tricare Prime will pay an annual enrollment fee in 2025 of $372 for a single member and $744 for a family for those in Group A; and $450 for a single member and $900.96 for a family for those in Group B.
Catastrophic Cap
The catastrophic cap is the maximum amount you will pay out of pocket annually for all health care. The catastrophic cap resets each year.
Active-duty beneficiaries in Group A have a catastrophic cap of $1,000 in 2025, and Group B's is $1,288. Retired beneficiaries have a catastrophic cap of $3,000 for Group A or $4,509 for Group B.
Copay Amounts
In addition to an enrollment fee, you also may pay a copayment for various services received at network providers. These fees are:
| Service | Active-Duty Cost | Group A Retiree Cost |
|---|---|---|
| Annual Deductible | $0 | $0 |
| Primary Care | $0 | $25 |
| Specialist | $0 | $38 |
| Urgent Care | $0 | $38 |
| Emergency Room | $0 | $77 |
| Hospital | $0 | $193 |
For more details, visit the Tricare website.
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