Understanding Tricare

Understanding Tricare’s different coverage options.

First let’s start with what is Tricare?

“TRICARE is the uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.”

https://tricare.mil/Plans/New

Tricare plans include: Prime, Prime Remote, Prime Overseas, Prime Remote Overseas, Select, Select Overseas, for Life, Reserve Select, Retired Reserve, Young Adult, Plus, and US Family Health Plan. See https://tricare.mil/Plans/New for details on these plans

I am going to be talking about Tricare Prime for Active Duty Service Members and their beneficiaries and Tricare Select for Active Duty Service Members Beneficiaries. My experience is with Tricare East, mostly through Select. I switched from Prime to Select in 2021 when I was having trouble getting referrals to the integrative/functional medicine providers I needed to see. This website is a combination of my experience and research. While some things will be specific to Tricare East on Select, many of the systems apply to all Tricare beneficiaries, and even other insurance programs. I will differentiate between Select and Prime, and Active Duty Service Member care through Prime as much as possible, so you know your options. My goal is to give you clarity, so you know what is available to you and can access whatever holistic health care services you desire with confidence.

Tricare Plans for Active Duty component CONUS

Back to the two plans for Active Duty Service Members and their families in the United States: Tricare Prime and Tricare Select

Within Tricare in the US there’s two regions, East and West which both have their own carriers. Tricare East is Humana. Tricare West was Health Net Federal Services through 2024. They switched to TriWest Healthcare Alliance on January 1st, 2025. There was also a change in claims processing.

A word about the carrier switch: many non-network participating providers are not able to bill Tricare at this moment which means that they cannot make money for services provided. Tricare has responded that they are working on it but correcting the issue may take months. To stay in business many are asking clients to pay up front and providing a superbill to self submit for reimbursement. Tricare representatives have told me that the invidual reimbursement process has not changed, besides the website being updated to become more user friendly. Self submitting is quick and easy once you know exactly what to do. See “_____” for written and video instructions.

My experience is with Tricare East, mostly through Select. I switched from Prime to Select in 2021 when I was having trouble getting referrals to the integrative/functional medicine providers I needed to see. This website is a combination of my experience and research. While some things will be specific to Tricare East on Select (and I will annotate such), many of the systems apply to all Tricare beneficiaries. I will differentiate between Select and Prime, and Active Duty Service Member care through Prime, so you know your options.

Back to Tricare programs:

There are two categories of providers:

Network Providers (includes military providers) and Non-network Providers

Network Providers: Bills Tricare directly, must still to Tricare allowable rate so you do not pay extra. Usually your military or other large medical system providers. Beneficiaries can see non-network providers using the “point of service” option.

Non-Network Providers: Within non-network providers there’s participating and non-participating providers

Participating: bills Tricare directly, cannot charge more than the Tricare allowable rate, usually providers at more established, medium size clinics like family practices or med spas.

Non-Participating: may or may not bill Tricare directly, may or may not provide a superbill. They can charge more than the Tricare allowable rate which means you may have out of pocket costs. A lot of these doctors say "we do not work with insurance” but you can still get hundreds to thousands of dollars refunded to you by filing on your own. I will teach you how!

Tricare Prime has to see a network provider as their Primary Care Provider (PCM) and has to get referrals from their PCM for any additional care. Prime members can only see non-network providers if they:

1. Use point of service to see any Tricare authorized provider: these fees do not 

  apply to your catastrophic cap

Deductible: $300 individual/$600 family

50% cost share of Tricare’s allowable rate

2. Your regional contractor approves it because there are no other providers 

    available

Point of Service cannot be used by service members

Tricare Select can choose to see any Tricare authorized provider, both as their PCM and for speciality care.

A Tricare authorized provider is “any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under Tricare.”

Examples of Tricare authorized providers are people who hold the following credentials/certifications: MD, DO, PA, FNP, RD, SLP, LMFT, PT, DPT… this is not an inclusive list, there are more,

Examples of credentials/certifications that Tricare does not recognize include: Nutritional Therapy Practitioner, LMT*, Naturopathic Doctor, Doctor of Chiropractic*, Acupuncturist*, Doctor of Traditional Chinese Medicine … this is not an inclusive list.

*These providers are sometimes covered inside of a military treatment facility

With Tricare Select you will have to pay a deductible, copays, and cost shares until you reach your catastrophic cap. See information below to understand your beneficiary category and group and your corresponding costs in the chart below for the exact rates for 2025. After you reach your cap you will not pay cost shares or copays any more.

Tricare Groups and Costs for 2025

I’m going to try to simplify something that is really complicated. Inevitably you might have questions. I am including monthly zoom calls and an in web messaging system as a part of the upgraded plan just as soon as I can get it going. I want to answer all of your individual questions, as much as I can.

Subscribe to read the rest of this post (behind the beneficiary paywall, under “blogs”) and learn all you need to confidently use Tricare for you and your family’s holistic/alternative health care needs.