FALLS CHURCH, Va. –
*Note: This article was updated April 29 to reflect the extension of the West Region referral approval waiver through June 30 and the West Region point-of-service fee waiver through Sept. 30.*
If you’re looking for a provider, it’s important to understand the different types of TRICARE providers you can see. The type of provider you see can determine how much you pay for care and the process for filing claims.
“Before getting care, always find out if your provider is TRICARE-authorized and in your TRICARE contractor’s network,” said Paul Wuerdeman, lead, provider networks, TRICARE Health Plan, at the Defense Health Agency. “Knowing your provider options will help you lower your costs and find the right care for your needs.”
Keep reading to learn about provider types and how to find a provider.
Network providers
Are you wondering which type of provider you should see? There are two main types of TRICARE providers:
Network and
non-network providers. Network providers have signed agreements to work directly with TRICARE, as described in the
TRICARE Choices in the United States Handbook. Seeing a network provider has several important benefits. Network providers:
- Charge lower costs for your care and won’t surprise you with extra bills above what TRICARE allows
- Take care of filing your claims, which means less paperwork for you
- Have agreed to follow TRICARE’s rules and procedures for your care
Network providers are often your most affordable and convenient choice. You’ll only have to pay your cost-share to a network provider.
Non-network providers
Non-network providers can treat TRICARE beneficiaries, but they don’t have direct agreements with TRICARE. There are two types of non-network providers you should know about: participating non-network providers and non-participating providers.
Participating non-network providers will:
- Accept TRICARE’s payment rate for your care
- Only bill you for your share of the costs
- Handle your claims paperwork for you
Non-participating providers might:
- Charge you more than what TRICARE allows, resulting in higher out-of-pocket costs
- Ask for full payment before they treat you
- Expect you to file your own claims
Important: Remember to ask non-network providers if they’re TRICARE-authorized before getting care—even if they’ve accepted TRICARE in the past. If they aren’t TRICARE-authorized, TRICARE won’t pay for any part of your claim.
How to find a provider
You have several options to search for providers:
If you live in the West Region, your regional contractor is now TriWest Healthcare Alliance. You can access the TriWest provider directory.
If you live in the East Region, check out the Humana Military network provider directory.
If you live overseas, use the International SOS provider directory to locate nearby providers.
Note: TRICARE has a Preferred Provider Network in the Philippines. Non-network providers in the Philippines must be certified to be covered by TRICARE, except for emergency services. Providers in the PPN:
- Accept network copayments and cost-shares
- File claims for you
Learn more about getting care in the Philippines on the TRICARE website.
Rules for different TRICARE plans
Your TRICARE plan determines the rules for which
providers you can see. Here’s what you need to know about each plan.
If you have TRICARE Select, TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult - Select Option, you can:
- Visit any provider who is approved by TRICARE
If you have TRICARE Prime, including TRICARE Young Adult - Prime Option:
- You get routine care from an assigned or selected primary care manager.
- Your PCM may be at a military hospital or clinic or a civilian TRICARE network provider.
- You’ll need a referral for specialty care and some diagnostic services.
- Note: Do you live in the West Region? There is a referral approval waiver in place through June 30. This means you still need to get a referral for specialty care, but you don’t need to wait for TriWest to approve the referral before seeing the specialist.
- You can use the point-of-service option to see a non-network provider, but you may have higher costs.
- Important: Do you live in the West Region? Through Sept. 30, you won’t have to pay POS fees for care received from a non-network provider. The Defense Health Agency has issued a waiver for POS fees, as long as the provider is TRICARE-authorized. Starting Oct. 1, if the provider is still a non-network provider and isn’t named on your referral or pre-authorization, you’ll need to pay POS fees.
If you have TRICARE Prime Remote:
- You can see non-network providers if no network providers practice in your area.
If you have TRICARE For Life:
Keeping costs low
You can take several steps to keep your healthcare costs down:
- Choose network providers whenever possible.
- Check if you need TRICARE’s approval before getting treatment.
- Ask providers if they’re TRICARE-authorized before making appointments.
- Learn and follow your plan’s specific rules about getting care.
To learn more about making appointments and getting the care you need, visit the TRICARE website.