FALLS CHURCH, Va. – If you’re getting care outside of a military hospital or clinic, it’s important to understand your civilian provider options. With TRICARE, there are two types of civilian providers: network and non-network. The type of provider you see can determine how much you pay and your process for filing claims.
You should know that TRICARE’s new regional contracts, which begin Jan. 1, 2025, will affect the TRICARE provider networks in the U.S. You’re now able to check the network provider directories for both the East Region and West Region.
“It’s recommended to start looking through the network provider directories now, so you know which providers are in the network in the new year,” said Paul Wuerdeman, lead, provider networks, TRICARE Health Plan, at the Defense Health Agency.
Here’s how to see if your providers will remain in the TRICARE network on Jan. 1.
Viewing network provider directories
If you live in the West Region, or a state that’s moving to the West Region on Jan. 1, your new regional contractor is TriWest Healthcare Alliance. TriWest’s network provider directory is available at tricare.mil/west. You should use this directory to see which providers will be in the network for care you get starting Jan. 1.
Note: Are you planning to get care between now and Dec. 31? Keep using the Health Net Federal Services, LLC network provider directory to find a network provider.
If you live in the East Region, Humana Military will remain your regional contractor. This means you can keep using the same Humana Military network provider directory in the new year.
These network provider directories are continuously updated as new providers join the network.
Not sure of the differences between a network and non-network provider? Keep reading to learn more.
Network providers
A network provider is part of TRICARE’s contract network, as outlined in the TRICARE Choices in the United States Handbook. These providers have an agreement with TRICARE to follow specific rules.
Here’s what to expect from network providers:
- Care agreements: Network providers have signed a contract with TRICARE to offer services at pre-determined rates.
- Cost-sharing: They accept your network copayment or cost-share as payment in full, which can lower your costs.
- Claims processing: Network providers handle claims directly with TRICARE. This means you don’t have to file them yourself.
If you have TRICARE Prime Overseas or TRICARE Prime Remote Overseas, network providers offer cashless, claimless services. This means you don’t have to pay upfront or file claims.
Non-network providers
Non-network providers aren’t part of the TRICARE network. But they’re authorized to provide care to TRICARE beneficiaries.
Non-network providers fall into two categories:
- Participating providers: These providers file claims for you and accept payment from TRICARE. They agree to the TRICARE-allowable charge, which includes your copayment or cost-share.
- Nonparticipating providers: These providers haven’t agreed to the TRICARE-allowable charge. They may charge more than this rate for care. If you see a nonparticipating provider, you may need to pay upfront and file a claim for reimbursement.
Here are some important things to consider when getting care from a non-network provider:
- Upfront costs: Non-network providers might ask you to pay for services at your visit.
- Additional charges: In the U.S., non-network providers may charge you above the TRICARE-allowable amount.
- Claims responsibility: With non-network providers, you may need to file your own claims.
Are you living or traveling overseas? The TRICARE Overseas Program Handbook describes what you need to know about non-network care.
Remember: If you get care from a non-TRICARE-authorized provider, you’ll be responsible for the full cost of your care. Before getting care, encourage them to check out how to become a TRICARE provider.
TRICARE For Life
If you have TRICARE For Life, you can choose among Medicare participating, non-participating, or opt-out providers. Each type of Medicare provider is different, so be sure to review the Medicare Provider Directory to learn more.
Finding a provider
To locate a TRICARE provider, you can use the Find a Doctor tool or browse All Provider Directories. Or visit your regional contractor’s website to search their online directory:
*Note: In the Philippines, TRICARE has a Preferred Provider Network. PPN providers:
- Accept network copayments and cost-shares
- File claims for you
- Important: Non-network providers in the Philippines must still be certified to be covered by TRICARE, except for emergency services.
Remember: If you live in the West Region and want to find a network provider, you should use the:
Some services may require a referral or pre-authorization, depending on your TRICARE health plan. Remember to check the provider type before you get care, so you know what to expect.
Do you have more questions about how the new TRICARE contracts may affect you in 2025? Check out these articles on the TRICARE Newsroom:
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