What are my TRICARE health care provider options? > TRICARE Newsroom > TRICARE News

Looking for a new doctor for you or your family? In your search, you may see terms like “TRICARE-authorized provider,” “network provider,” and “non-network provider.” Knowing the meaning of these terms can help you choose which provider to see.

A TRICARE-authorized provider is a provider approved by TRICARE to provide health care services to beneficiaries.

“Before receiving care from a civilian provider, it’s important to make sure the provider is TRICARE-credentialed,” said Paul Werdeman, TRICARE Health Plan provider networks lead for the Defense Health Agency. “The provider must be authorized by TRICARE in order for TRICARE to pay any portion of your claim.”

There are two types of TRICARE-authorized providers: network providers and out-of-network providers. Read on to learn about these providers and how to find providers near you.

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

  • You have accepted the agreed price as full payment for covered services.
  • We will not ask you to pay amounts above your copayment or cost sharing.
  • File claims for you.

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

An out-of-network provider is a TRICARE-authorized provider that does not have an agreement with TRICARE.

There are two types of out-of-network providers:

  • Participating Providers accept the TRICARE-allowable fee as payment in full for covered services. This means that you will only have to pay your share of the cost when you see the provider. Plus, you won’t have to file claims.
  • Non-Participating Providers are usually the most expensive option for a provider. This is because they have not agreed to accept the TRICARE allowable fee. Instead, they can charge up to 15% more than the TRICARE allowable fee. When you see a non-participating provider, you should expect to pay the provider in advance. You will then need to file a claim with TRICARE for reimbursement. Note that you will not be reimbursed for cost-sharing or any fees above the TRICARE allowable fee.

You can see out-of-network providers if you have TRICARE Select, TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult Select. If you have TRICARE Prime Remote, you can use out-of-network providers if network providers are not available in your remote location.

If you are enrolled in TRICARE Prime, you may see an out-of-network provider only if:

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

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 visiting an out-of-network provider, check to see if they accept TRICARE patients. Out-of-network providers who have accepted TRICARE in the past may not always accept TRICARE.

Do you have TRICARE For Life? As stated in TRICARE Handbook for Life, you can get health care services from participating and non-Medicare 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 be aware that you will have significant out-of-pocket costs when you receive care from providers who opt out.

If you are receiving services for which TRICARE For Life is the primary payer, you must visit TRICARE-authorized providers and facilities.

Want to avoid surprise expenses? Knowing the type of provider you see and the rules of your care plan can help. Network providers generally have lower out-of-pocket costs than out-of-network providers. If you’re not sure whether you’re seeing a network or non-network provider, ask before you get care.

Remember that some services from your provider may require a referral or prior authorization. This depends on your health plan. Go to Book Appointments to learn how to get care with your plan.

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