Active Duty Family Tricare Options: Prime, Select, Or US Family Health Plan?

This entire article is for Active Duty family members. For a similar conversation for retirees, see this article.

Military families are blessed to have two (or three) different health plans from which to pick. If you’re not familiar with the ins and outs of each plan, it can be hard to pick. Which health care coverage should I choose?

The first thing to do is to see which plans you are eligible to use, based upon your location. You can find your options by using the Tricare Plan Finder. It will ask your eligibility status and location, and tell you which plans are available there.

Tricare Prime, not USFHP

With regular Tricare Prime, active duty family members receive care at a MTF unless they can not accommodate you and send you out into town. It’s possible that your nearest MTF won’t have room for you and that Tricare will expect you to travel to a different MTF before they send you to civilian providers. In most cases, you will be sent to Walter Reed for specialty care.

Prescriptions are filled at any MTF, or you can use civilian pharmacies that accept Tricare (with co-payments) or you can use the Express Scripts mail order pharmacy.

You do not pay for your medical care at MTFs or when referred to a civilian provider. You will pay for a relatively hefty portion of your care if you go to a provider who is not in the network or you don’t have a referral for non-emergency care. (This is called Point of Service and it can add up in specific situations. Also, Tricare Prime Point of Service costs DO NOT apply to your catastrophic cap.)

One important difference between Tricare Prime and Tricare Select is that IF you are on Tricare Prime, and you require specialty care that can not be provided near your home, and you have a valid referral for that care, Tricare Prime may reimburse your travel expenses. This can be huge if you are receiving specialty treatment far from home, especially if it includes hotel stays.

Tricare Select

With regular Tricare Select, get your care from authorized civilian providers. In theory, you are able to obtain care from MTF on a space available basis, but that’s not the general idea of the program.You do not require referrals for most specialty care, but certain services may require pre-authorization.

Prescriptions are filled at any MTF, or you can use civilian pharmacies that accept Tricare (with co-payments) or you can use the Express Scripts mail order pharmacy.

Each year, you will pay a deductible, and then co-pays for most care and prescriptions, until you reach your catastrophic cap. Once you reach your catastrophic cap, you will only have costs if you go to non-network providers. Deductibles, co-pays, and catastrophic caps may change each year, so you have to know the current information to know what’s going on.

Note: If you use Tricare Select, you may be interested in a Tricare Supplement.

Uniformed Services Family Health Plan

While the USFHP is technically part of Tricare Prime, there are enough differences that it is effectively a third choice. (There is one situation where that is important to know – we’ll get to that later!)

What Is A USFHP?

A USFHP is a provider of Tricare Prime services. I know it’s a little confusing to think of USFHP as being part of Prime, because there are such visible differences. But at the core of the program, they are very similar: you still have a primary care manager (PCM), and you still require referrals for most care beyond your PCM.

The reason it is important to know that a USFHP is a provider for Tricare Prime is because that means that you can switch from MTF-based Tricare Prime to USFHP Tricare Prime (or the other way) without having to wait for the annual open season. You can switch back and forth at any time during the year without having a qualifying life event, because it’s technically just a PCM change, not a plan change.

It’s important to understand that there are USFHPs in the country. If you do an internet search on USFHP, you may go to a page for another plan. They’re often not very clear. I once spent 45 minutes on the phone with a USFHP rep from the Johns Hopkins plan, trying to understand why they were telling me one thing when the handbook said something different, before I figured out that I was reading the handbook for a different USFHP.

The other important thing to consider is that while it is a large network, the USFHP is still network-based plan. If you want to go see a specialist that is not in the network, you’ll need to get authorization from the plan and demonstrate why they can’t meet their needs within their network.

How the USFHP Works

If you have selected an USFHP as your Tricare Prime PCM, you can not use any MTF for your medical care. You go to civilian doctors, with the same referral requirements as prime.

USFHP members can not use the MTF pharmacies and must fill their prescriptions at the designated civilian pharmacy, or use the USFHP mail order pharmacy.

You do not have copays for your care, but you do have copays for prescriptions.

Why We’ve Picked Tricare Select

Our family has used Tricare Prime, an USFHP, and Tricare Select. Our last switch was from USFHP to Tricare Select, and we’re not switching back. We have five people using Tricare (not including the active duty one), and that includes two away at college outside the USFHP region, and one special needs kid.

We were paying almost $1,000 per year just in pharmacy co-pays on USFHP, though we could have shaved that amount by using the mail order pharmacy more often.

Plus, the kid at college was on “regular” Prime because her school was outside our USFHP region. Her choices of PCMs was severely limited at her location. Even worse, she had a doctor who was not in-network, so we were paying Point of Service costs for that care. (And those POS costs do not apply to your catastrophic cap when you are on Prime.)

So we were paying almost $1,000 per year for prescriptions,  plus the Point of Service deductible plus the 50% of her POS appointments, and we had to use in-network providers, get referrals for everything, and use that one specific pharmacy. Under Select, we pay the deductible and then co-pays, but once we reach our catastrophic cap (which is just $1,000 for active duty families whose sponsor entered the military prior to 1 January 2018), we are done until next January. When we need a specialist (which is all the time here), I just call and make sure that they are an in-network provider.

Obviously, this is a relatively simple overview, but I think I’ve hit most of the big points. I wasn’t unhappy with the USFHP – it was a lot easier that Prime, for me – but I love Select and it isn’t costing us any more. $83/month (the $1000 catastrophic cap divided by 12 months) is absolutely worth my time and energy, plus my kids are already getting better care because I have a better selection of providers.