TRICARE Prime Demo & Pilot Programs Guide (2026) | TRICARE.com

*TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For the official government website, please visit TRICARE.mil.*

## Quick answer A TRICARE Prime Demonstration (or "Demo") is a temporary, geographically limited program designed to test new ways of delivering healthcare or managing costs. These demos, such as the **TRICARE Prime Remote** (which started as a demo) or specialized pilot programs for certain bases, often allow eligible members to receive Prime-level benefits even if they live outside a standard Prime Service Area (PSA).

Details

TRICARE uses demonstration projects to evaluate changes in medical benefits, pharmacy services, or provider reimbursement before making them permanent law. While "TRICARE Prime" is the standard HMO-style benefit, a "Demo" version modifies the standard rules for a specific group of people.

### Current and Notable Prime-Related Demos As of 2026, many programs that began as "demos" have been codified into permanent benefits. However, active research and pilot programs often include:

* **TRICARE Prime Remote (TPR):** Though now a permanent benefit, this began as a demo to provide Active Duty Service Members (ADSMs) and their families the same $0-copay coverage as Prime, even when stationed in remote areas far from a Military Treatment Facility (MTF). * **The Autism Care Demonstration (ACD):** This is one of the most significant active demonstrations. It provides TRICARE Prime and Select beneficiaries with Applied Behavior Analysis (ABA) services. Under 2026 guidelines, participants must meet specific diagnostic criteria and follow a comprehensive care plan to maintain eligibility. * **Value-Based Care Pilots:** In the current T-5 contract cycle (administered by **Humana Military** in the East and **TriWest** in the West), TRICARE is testing specific "Value-Based" models where Prime referrals might be streamlined for high-performing specialty groups.

### Costs and Enrollment * **Active Duty:** Always $0 out-of-pocket for covered care under any Prime demo model. * **Retirees:** For specific demos like the ACD, retirees may still be responsible for their standard Prime enrollment fees (e.g., approximately $392/individual or $784/family for Group A retirees in 2026, though rates vary by plan year). * **Point of Service (POS) Fees:** In almost all Prime Demos, if you see a provider without a referral (when one is required), you will be charged POS fees. For 2026, this typically includes a $300 deductible and 50% of the allowed cost.

### Regional Management If you are enrolled in a demonstration program, your care is managed by the regional contractor: * **East Region:** Humana Military * **West Region:** TriWest Healthcare Alliance (as of the 2025 T-5 transition)

## Who this affects * **Active Duty Service Members (ADSMs):** Primarily those in remote locations or requiring specialized pilot-program care. * **Active Duty Family Members (ADFMs):** Specifically those enrolled in the Autism Care Demonstration or living in Remote areas. * **Retirees and their Families:** Only when specifically included in a pilot study or the Autism Care Demo. * **National Guard and Reserve:** Those on active duty orders for more than 30 days who qualify for Prime Remote.

## Sources * **TRICARE.mil:** [Demonstration Projects Page](https://www.tricare.mil/demos) * **Defense Health Agency (DHA):** [Autism Care Demonstration](https://www.tricare.mil/autism) * **TriWest Healthcare Alliance:** [West Region Provider Demographics](https://www.triwest.com) * **Humana Military:** [East Region Benefits](https://www.humanamilitary.com)