An official website of the United States government
A .mil website belongs to an official U.S. Department of Defense organization in the United States.
A lock (lock ) or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

News | Jan. 9, 2024

What To Know Before Getting Care With Your TRICARE Plan

By TRICARE Communications

Did you or a family member recently enroll in a TRICARE health plan or change plans? Now is a good time to review how your plan works.
 
“Knowing what to do before and after you get care is key to making the most of your TRICARE plan,” said Zelly Zim, a senior analyst with TRICARE Policy and Programs at the Defense Health Agency. “Understanding your plan, TRICARE covered services, and costs will help you and your family prepare for your health care needs in the year ahead.”
 
Here are some key things to do and know before getting care.
 

1.  Know which plan you’re enrolled in

Different TRICARE plans have different rules and out-of-pocket costs for getting care, as detailed in the TRICARE Plans Overview Fact Sheet. That’s why it’s important to know which TRICARE plan you’re enrolled in.
 
If you aren’t sure which plan you have, there are two ways to check. You can log in to the Defense Enrollment Eligibility Reporting System (DEERS) through milConnect or call your regional contractor.
 
Don’t forget to update DEERS whenever you have a change in your sponsor’s status, get married or divorced, have a baby, move, become eligible for Medicare, or if your sponsor or family member dies. These are Qualifying Life Events (QLEs), which may open a period where you can make changes to your plan.
 
Remember to keep your contact information (address, email address, and phone number) updated in DEERS and with your regional contractor. 
 

2. Know where you can get care

Knowing where you can get care with your plan is one way to avoid unexpected costs.
 
You may be able to get care at a military hospital or clinic. This depends on your plan, location, and beneficiary category. You have priority at military hospitals and clinics if you’re an active duty service member (ADSM) or you have a TRICARE Prime plan. (This doesn’t include the US Family Health Plan.)
 
You may also be able to get care from TRICARE-authorized civilian providers. Use the provider directories to search for TRICARE-authorized providers near you. Civilian providers may be either network or non-network:
  • Network providers have signed an agreement with a TRICARE contractor to follow TRICARE’s policies and procedures. If you see a network provider, you’ll only pay your in-network copayment or cost-share.
  • Non-network providers haven’t signed an agreement with a TRICARE contractor. There are two types of non-network providers: participating and non-participating. Non-participating providers are typically the most expensive provider option.
 
Your plan determines if you need a referral or pre-authorization to see these providers. ADSMs and other TRICARE Prime beneficiaries need referrals for any care their primary care manager (PCM) does not provide. In these cases, your PCM will refer you to another provider or specialist.
 
Beneficiaries enrolled in all other TRICARE plans only need referrals or pre-authorizations for certain services.
 

3. Find what TRICARE covers

TRICARE covers care that’s medically necessary and considered proven. This includes preventive care and mental health and substance use disorder care. You can use the TRICARE Covered Services tool to see if a health service or supply is covered or not.
 

4. Review your out-of-pocket costs

Your health care costs may include deductibles, copayments, and cost-shares. These costs depend on your plan, your sponsor, where you get care, and the type of care you get.
 
Knowing your plan’s out-of-pocket costs up front can help you choose providers with lower costs and avoid unexpected costs. If you don’t follow your plan’s rules for getting care, you may end up paying more out-of-pocket.
 
TRICARE Prime beneficiaries can also use the point-of-service option. This lets you see any TRICARE-authorized provider without a referral. With this option, you’ll pay more out-of-pocket. The point-of-service option doesn’t apply to ADSMs.
 
To learn more about costs for covered services, use the TRICARE Compare Costs tool or check out the TRICARE Costs and Fees Fact Sheet
 

5. Know how to file claims

Usually, your provider will file your claims for you. But if you get care while traveling, or from a non-participating provider, you may need to file your own claim.
 
It’s best to file your claim as soon as possible. File within one year of the date of service if you’re in the U.S. or U.S. territory, or within three years of the date of service if overseas. TRICARE claims processors process most claims within 30 days.
 
When submitting a claim, keep a copy of all paperwork for your records. If your claim is denied or you need help, contact your regional contractor.
 
TRICARE is here to support your family’s wellness and help you make the most of your benefits. To learn more about how to get care with your plan, visit Getting Care. If you have questions, call your regional contractor.
 
Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.
 
Map of West Region states and TRICARE logo. Text: Referral approval waiver: Referral approvals are waived through June 30.

Defense Health Agency Extends Referral Approval ...

News
Apr. 30, 2025

Do you live in the West Region? Do you have TRICARE Prime? You should know that the Defense Health Agency has...
Read More
TRICARE logo; map of West Region U.S. states in blue. Text reads "Attention West Region Beneficiaries: Submit your payments by April 30 to avoid disenrollment. If you are disenrolled, call TriWest at 888-TRIWEST to reinstate your TRICARE health plan."

Disenrolled From Your TRICARE Plan in the West R...

News
Apr. 29, 2025

Do you currently live in the TRICARE West Region? Do you pay for your TRICARE coverage using a bank electronic...
Read More
Drop off unused, unneeded, or expired drugs at military pharmacies in the U.S.

Safely Dispose of Unused Prescriptions on April ...

News
Apr. 24, 2025

Did you know that Saturday, April 26, is the next National Drug Take Back Day? It’s a day to safely dispose of...
Read More
TRICARE For Life Handbook graphic

Want To Learn About TRICARE For Life? Check Out ...

News
Apr. 22, 2025

You may be approaching age 65, or you may have a disability or a medical condition that makes you eligible for...
Read More
Smiling woman stands in front of American flag.

Unlock Your Health: Need Help With Your TRICARE ...

News
Apr. 18, 2025

Did you know that military hospitals and clinics have support staff who can help you navigate your TRICARE...
Read More
Four young children stand in a huddle, laughing and holding a soccer ball. Text reads: Stay in the Game - Stop Measles Before It Starts! Defense Health Agency and Unlock Your Health text.

Measles Cases on the Rise in the U.S.: Recognize...

News
Apr. 17, 2025

You may have heard about the ongoing measles outbreak in the U.S. Measles is a highly contagious illness that...
Read More
Uniformed service member answers phone standing in front of computer screen

TRICARE’s Near Patient Program: What To Know

News
Apr. 15, 2025

For service members and their family members living overseas, challenges like language barriers and unfamiliar...
Read More
Graphic with TRICARE logo that reads, "Patients needed on April 25 for a focus group discussion on menopause. Sign up deadline is April 24. Learn if you qualify." Drawing of three womn sitting around a laptop.

Provide Feedback on Clinical Practice Guidelines...

News
Apr. 10, 2025

Did you know that your feedback could be a key ingredient in developing health policies, treatments, and...
Read More

April 30, 2025

Defense Health Agency Extends Referral Approval Waiver Through June 30 for West Region TRICARE Prime Enrollees

Do you live in the West Region? Do you have TRICARE Prime? You should know that the Defense Health Agency has extended the West Region referral approval waiver through June 30. TRICARE-authorized specialty care providers don’t need to wait for TriWest Healthcare Alliance to approve referrals issued by your primary care manager before providing outpatient care.

April 29, 2025

Disenrolled From Your TRICARE Plan in the West Region? Here’s How To Reinstate Your Coverage After April 30

Do you currently live in the TRICARE West Region? Do you pay for your TRICARE coverage using a bank electronic funds transfer, credit card, or debit card? If you haven’t done so already, you must securely provide your payment information to the West Region contractor, TriWest Healthcare Alliance, by April 30. If you haven’t submitted payment to TriWest by April 30, you and your family members will be disenrolled from your TRICARE plan on May 1. This disenrollment is retroactive to your paid-through date.

April 24, 2025

Safely Dispose of Unused Prescriptions on April 26, National Drug Take Back Day

Did you know that Saturday, April 26, is the next National Drug Take Back Day? It’s a day to safely dispose of unwanted, expired, or excess medications. But it’s also important to know that military pharmacies offer ways to safely dispose of drugs all year long through the Military Health System Drug Take Back program.

April 22, 2025

Want To Learn About TRICARE For Life? Check Out This Handbook

You may be approaching age 65, or you may have a disability or a medical condition that makes you eligible for Medicare and TRICARE For Life before you turn age 65. In either case, you’ll benefit from checking out the TRICARE For Life Handbook.

April 18, 2025

Unlock Your Health: Need Help With Your TRICARE Benefit? A Beneficiary Counseling and Assistance Coordinator Can Help

Did you know that military hospitals and clinics have support staff who can help you navigate your TRICARE benefit? These include Beneficiary Counseling and Assistance Coordinators. You can find them at any military hospital or clinic.

April 17, 2025

Measles Cases on the Rise in the U.S.: Recognize the Symptoms and Protect Your Family

You may have heard about the ongoing measles outbreak in the U.S. Measles is a highly contagious illness that can cause serious complications. Anyone who isn’t protected against measles can get the illness—and children are especially at risk of getting seriously sick.

April 15, 2025

TRICARE’s Near Patient Program: What To Know

For service members and their family members living overseas, challenges like language barriers and unfamiliar health systems may make getting medical care stressful. But getting health care overseas doesn’t have to be difficult. Luckily, TRICARE offers the Near Patient Program to help monitor your medical care and assist you in ten overseas locations.

April 10, 2025

Provide Feedback on Clinical Practice Guidelines in Joint DOD, VA Patient Focus Groups: Menopause Discussion on April 25

Did you know that your feedback could be a key ingredient in developing health policies, treatments, and models of care for the military and veteran healthcare systems? The Department of Defense and Veterans Health Administration are seeking volunteers for four upcoming virtual patient focus groups. The next focus group, on diagnosing and treating menopause, is on April 25 at 2 p.m. ET. The deadline to register is April 24 at 5 p.m. ET.

April 8, 2025

New TRICARE Drive Time Waiver Policy Makes it Easier To Keep Your Primary Care Manager if You Move

Are you moving to a new home? Is it more than a 30-minute drive from your primary care manager? If so, TRICARE is making it simpler to keep your TRICARE Prime coverage. Now, most families who live more than 30 minutes but less than 100 miles from their PCM can continue seeing them without taking action.

April 3, 2025

Q&A: Your TRICARE Catastrophic Cap

You can’t always predict your family’s healthcare needs. But you can know the most you could have to pay for TRICARE covered services. TRICARE calls this your catastrophic cap. Your catastrophic cap limits how much you and your family will pay for TRICARE covered healthcare services each calendar year.