The Pros & Cons of Tricare Prime and Tricare Select Plans
Monica Cistrone NP-C- Oct 29, 2022
- 5 min read
Updated: Apr 22
Military families are fortunate to have two solid health plan options: Tricare Prime and Tricare Select. Both plans provide excellent coverage, but each comes with unique features tailored to different needs. Choosing between them depends on your family’s healthcare priorities, like flexibility, cost, and provider choice. In this blog post, we'll dive into the key distinctions, highlighting the benefits and trade-offs of each option. By the end, you’ll have a clearer picture of which plan best suits your lifestyle and healthcare preferences. Let's explore how Tricare Prime and Tricare Select stack up!
IWC Primary Care, An Innovative Wellness Clinic part of Sharp Community Medical Group
-Located in the Spring Valley Community in San Diego, CA
Tricare Prime vs. Tricare Select
When choosing between Tricare Prime and Tricare Select, it comes down to how you want your healthcare managed and whether you prefer to receive care on base. Let’s break down the essentials to make it simple.
Tricare Prime: The Managed Care Option
Tricare Prime is designed for those who like structure and simplicity in their healthcare, with a focus on a coordinated care experience.
Receive Care On-Base or In-Network: With Tricare Prime, you’ll receive care on base or from a network of Tricare-approved doctors and hospitals. This means you’re set up with a dedicated network that Tricare trusts to handle your care.
Primary Care Manager (PCM): Tricare Prime assigns you a Primary Care Manager (PCM), who acts as the main point of contact for your health. They manage your routine care and, when needed, provide referrals to specialists.
Specialist Access: To see a specialist, you’ll need a referral from your PCM. This referral process ensures that everyone on your care team is in sync. While it adds a step, it can make navigating the system easier, as your PCM coordinates directly with the specialist.
No Deductibles or Co-Pays: One of the big perks of Prime is no deductibles or co-pays for in-network primary or specialty care. You’ll have an annual enrollment fee (unless you’re an active-duty family member, in which case it’s waived). After that, most of your care is covered.
Who’s It Good For?
Tricare Prime is great for those who prefer the security of a managed network, easy budgeting without unexpected costs, and want to receive care on base or within Tricare’s established network.
Tricare Select: The Flexible Choice
Tricare Select is all about giving you the freedom to choose your healthcare providers without a network restriction.
See Any Doctor That Accepts Tricare: With Tricare Select, you’re not limited to a set network. As long as a provider accepts Tricare, you’re free to choose them, whether they’re on base or off.
No Primary Care Manager Required: Unlike Tricare Prime, you don’t need a Primary Care Manager with Select. You can self-refer to specialists without needing a PCM’s sign-off. However, keep in mind that many specialists prefer to review your chart notes and diagnosis from a primary care doctor first. So, while it’s not required, visiting a primary doctor first can sometimes help ensure a smooth referral process.
Deductibles and Co-Pays: Select does have an annual deductible and co-pays for office visits, prescriptions, and other services. These costs vary depending on whether your provider is in-network or out-of-network, so it’s a bit more pay-as-you-go compared to Prime.
Ideal for Off-Base Care: Tricare Select is a strong choice if you prefer the flexibility to see any provider and want the option to receive care outside of military bases.
Who’s It Good For?
Tricare Select is best for those who value flexibility and don’t mind a little extra cost to have control over their care. It’s great if you prefer seeing providers off base and want the freedom to choose your own specialists.
Understanding the Referral Process:
When it comes to seeing specialists, Tricare Prime and Tricare Select handle things a bit differently, and knowing these differences can save you time and hassle.
With Tricare Prime, your Primary Care Manager (PCM) is your main point of contact for all your healthcare needs. If you ever need to see a specialist, your PCM will issue a referral, guiding you to the right in-network specialist and ensuring all the paperwork is handled along the way. This extra step means your care is fully coordinated and that your PCM can keep up with any updates on your condition. It’s like having a healthcare coach who makes sure everything flows smoothly!
On the other hand, Tricare Select gives you the freedom to see specialists without needing a referral. You’re in charge of picking your provider, so you can go directly to a specialist if you prefer. But here’s a helpful tip: specialists usually appreciate having background info, like chart notes or a diagnosis from a primary doctor. So, even though referrals aren’t required, a quick visit to your regular doctor beforehand can make things easier for everyone and ensure the specialist has the full picture.
In a nutshell, Tricare Prime keeps things coordinated with referrals, while Tricare Select offers more independence, letting you decide how to approach specialty care. Whether you prefer structured support or a little more flexibility, knowing how each plan handles referrals can make a big difference in your healthcare experience!
Which plan is right for you?
According to the experiences we have with our Tricare patients at IWC Primary Care, the best way to determine which plan is right for you is to consider your particular needs and circumstances.
Are you comfortable sticking to a network of doctors, or do you prefer the flexibility of being able to see anyone?
Do you need regular access to specialists, or can you wait to get a referral from your primary care doctor?
Are you willing to pay more out-of-pocket costs in exchange for lower premiums?
By answering these questions, you should be able to narrow down your choice to either Tricare Prime or Tricare Select.
Both Tricare Prime and Tricare Select offer great coverage for military families. The best way to decide which plan is right for you is to consider your specific needs and situation. If you're comfortable with a managed care system and don't mind sticking to a network of doctors, then Tricare Prime may be the right choice for you. However, if you prefer the flexibility of being able to see any doctor that accepts Tricare, then Tricare Select may be a better option. Whichever plan you choose, you can be sure that you're getting great coverage for yourself and your family.
Welcome to IWC Primary Care, part of the esteemed Sharp Community Medical Group (SCMG). We are a Family Medicine Practice in Spring Valley, a suburb in San Diego, CA dedicated to delivering top-notch healthcare services include precise diagnosis, tailored medication prescriptions, and diligent follow-ups to ensure your well-being.
We take a patient-centered approach to healthcare. Our commitment to excellence is evident from the moment our patients step through our doors: they are greeted with warmth and kindness by front office staff before being seen by our professional, yet friendly primary care providers. Our primary care team provides a tailored and personalized experience with compassionate support. Using both conventional and integrative medicine, we can address potential issues before they happen. We promise to listen and understand your health concerns during your appointment.
Our passionate clinical team strives to provide top-tier services that prioritize everyone's unique needs. We integrate both conventional and integrative medicine into our treatment plans for maximum efficacy in addressing potential issues before they can arise. During your appointment we promise a fully attentive experience focused on listening and understanding all concerns regarding your wellbeing.
Find us on Google listed under "Tricare Doctor Spring Valley" or simply search "Clinics near me that accept tricare."
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