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What Are My TRICARE Health Care Provider Options?

There are two types of TRICARE-authorized providers: network providers and non-network providers.

 

Network providers

 

network provider is any TRICARE-authorized provider that has signed an agreement with your regional contractor. Network providers have agreed to follow TRICARE’s policies and procedures. This means that they:

  • Have agreed to the contracted rate as payment in full for covered services
  • Won’t ask you pay amounts above your copayment or cost-share
  • File claims for you

 
Do you live overseas? Network providers overseas also have an agreement with the TRICARE overseas contractor. However, network providers only agree to provide cashless and claimless services to those who have TRICARE Prime Overseas or TRICARE Prime Remote Overseas. If you have TRICARE Select Overseas, you may have to pay up front to get services or file your own claims when you see a network provider.


 

Non-network providers

 

non-network provider is a TRICARE-authorized provider that doesn’t have an agreement with TRICARE.
 
There are two types of non-network providers:

  • Participating providers accept the TRICARE-allowable charge as payment in full for covered services. This means you’ll only have to pay your cost-share when you see the provider. You also won’t have to file claims.
  • Non-participating providers are typically the most expensive provider option. That’s because they haven’t agreed to accept the TRICARE-allowable charge. Instead, they can charge up to 15% more than the TRICARE-allowable charge. When you see a non-participating provider, you should expect to pay the provider up front. Then you’ll need to file a claim with TRICARE for reimbursement. Keep in mind that you won’t be reimbursed for your cost-share or any charges above the TRICARE-allowable charge. 

 
You can see non-network providers if you have TRICARE SelectTRICARE Reserve SelectTRICARE Retired Reserve, or TRICARE Young Adult Select. If you have TRICARE Prime Remote, you can use non-network providers if network providers aren’t available in your remote location.
 
If you’re enrolled in TRICARE Prime, you may see a non-network provider only if:

  • You decide to use the point-of-service option, or
  • Your regional contractor approves it because no other providers are available

 

 

How to find TRICARE-authorized providers

 

To find a network or non-network provider near you, you can use the Find a Doctor tool. You can also go to All Provider Directories

Before you visit a non-network provider, check to see if they accept TRICARE patients. Non-network providers who have accepted TRICARE in the past may not always accept TRICARE.


 

Medicare and TRICARE For Life providers

 

Do you have TRICARE For Life? As outlined in the TRICARE For Life Handbook, you may get health care services from Medicare participating and Medicare non-participating providers. Go to Medicare.gov to find providers near you.
 
You can also get care from providers who have opted out of Medicare. But keep in mind that you’ll have significant out-of-pocket expenses when you get care from opt-out providers. If you get services for which TRICARE For Life is the primary payer, you must visit TRICARE-authorized providers and facilities. 

 


*For more from TRICARE/DHA, visit their M:M Expert Author Page.

 

 

Author

  • Defense Health Agency

    The Defense Health Agency is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime. Their mission is to provide a medical benefit commensurate with the service and sacrifice of more than 9.6 million active duty personnel, military retirees and their families.

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