FALLS CHURCH, Va. –
The first step in getting healthcare is to know where to go. TRICARE has many resources to help you
find the right healthcare provider for you and your family. Depending on your plan, you’ll get care from a military hospital or clinic or a civilian provider.
“TRICARE beneficiaries have access to large networks of providers. How they find a provider depends on their plan and location,” said Steve Martin, Provider Networks Senior Analyst, TRICARE Health Plan, at the Defense Health Agency. “TRICARE has a number of tools to help you navigate the system to find the care you need.”
Your care options
Military hospitals and clinics
Getting care at
military hospitals and clinics may be the simplest, most cost-effective route to high-quality care for you and your family. Be aware that if you have certain TRICARE plans, like
TRICARE Select, you can only get care at the military hospital or clinic if space is available. Even if you don’t get care at a military hospital or clinic, you can fill your prescriptions at
military pharmacies at no cost for up to a 90-day supply.
Civilian network and non-network providers
TRICARE’s
regional contractors work with thousands of authorized civilian providers in the U.S. and overseas. Depending on your plan, you may have access to network or non-network providers.
TRICARE-authorized providers that are part of the network cost you less and will file claims directly with TRICARE. Non-network authorized providers cost more, and you’ll have to file your own claims.
The Find a Doctor Tool can help you search for a TRICARE-authorized provider, no matter what plan you have or where you live.
Important: TRICARE won’t pay for care from a non-authorized non-network provider.
Virtual health and the Military Health System Nurse Advice Line
Need a little convenience? TRICARE’s
virtual health benefit lets you see a doctor, nurse, or mental health professional without leaving home. You can use secure video calls, phone appointments, or other technology to get care.
Costs for virtual health visits are the same as for in-person care. Your costs depend on who you are (for example, active duty family member, retiree), and your TRICARE plan. Visit TRICARE Costs for more.
Referrals for virtual health visits follow the same rules as in-person care. The virtual health platforms you can use depend on the region you live in.
East Region
West Region
Overseas
If you’re overseas, the country you’re in must allow virtual health visits, and your provider must have a license to practice there. U.S.-based providers can’t provide virtual health visits overseas. Contact the
TOP Regional Call Center to find a provider who offers virtual visits, and to see if you need a referral.
With TRICARE For Life, you can access many virtual services available to the public. Medicare covers certain virtual health visits, but coverage depends on where you live and the type of care you need.
If you’re unsure you need an appointment, contact the MHS Nurse Advice Line to speak to a registered nurse any time, day or night. Ask questions, get healthcare advice, get connected virtually, or find out if you should get care.
Emergency and urgent care
No matter what TRICARE plan you have, or where you are, TRICARE covers
emergency care. Emergency care means care for an illness or injury that threatens your life, limb, sight, or safety. If you reasonably believe you have an emergency, always call 911 or your international emergency number. Or, go to the nearest emergency room.
If you go to an urgent care clinic, make sure you follow your plan’s rules for getting urgent care.
Your TRICARE plan choice
Depending on your
TRICARE plan, your first stop for care may be at a military hospital or clinic or a TRICARE-authorized civilian provider. Knowing where to start can save time, money, and paperwork.
Rules for booking appointments depend on which TRICARE plan you have. Active duty service members have their own rules, as described in the TRICARE Choices in the United States Handbook and TRICARE Overseas Program Handbook.
TRICARE Prime options
Compared to other TRICARE plans, TRICARE Prime has fewer out-of-pocket
costs, but less choice in providers. If you’re enrolled in a TRICARE Prime option, you’ll get most of your routine care from a
primary care manager.
A PCM can be a military provider or a civilian network provider. They’ll handle your routine, nonemergency, and urgent healthcare. If your PCM can’t provide your care, they’ll work with your regional contractor to refer you to a specialist. You may need referrals and pre-authorizations for certain services.
Go to milConnect or contact your regional contractor to find out who your PCM is or to make changes.
Note: TRICARE Prime options include (a TRICARE Prime option available through networks of community-based, not-for-profit health care systems in six areas of the U.S.) and the (a managed care option available to eligible beneficiaries in Atlanta, Georgia, and Tampa, Florida).
TRICARE Select and premium-based plans
With
TRICARE Select and most TRICARE premium-based plans, you can usually get care from any TRICARE-authorized network provider without a referral or
pre-authorization. You may need pre-authorization from your regional contractor for some services.
You’ll have lower out-of-pocket costs if you use a TRICARE-authorized network provider compared to a TRICARE-authorized non-network provider. To find a TRICARE network provider, use the Find a Doctor Tool or contact your regional contractor.
TRICARE For Life
With
TRICARE For Life, you can get care from either Medicare participating or Medicare non-participating providers. For both provider types, you’ll have no out-of-pocket costs for services covered by both Medicare and TFL. Most healthcare services fall into this category. After Medicare pays its portion of the claim, TRICARE pays the remaining amount, and you pay nothing. You may find
Medicare providers using the Medicare provider search tool. Learn more about how TRICARE works with
Medicare providers.
Outside the U.S. and U.S. territories, you’ll work with the overseas contractor to find an approved overseas provider. Learn more about using TRICARE For Life overseas.
TRICARE is there for you, no matter what plan you have, or where you go. Whether it’s routine care, a medical emergency, or care when you’re traveling, TRICARE has you covered.
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