TRICARE Benefits Guide: 2026 Coverage and Plans | TRICARE.com

*TRICARE.com is an independent reference site and is not the official TRICARE program or the Defense Health Agency. For official policy and the most current enrollment data, visit TRICARE.mil.*

## Quick answer TRICARE benefits provide comprehensive health coverage, including preventative care, outpatient visits, hospitalization, and pharmacy services for military service members and their families. Depending on your plan, benefits may be delivered through a managed care network (Prime) or a PPO-style system (Select), with costs determined by your "Group" status and your sponsor's military standing.

## In detail TRICARE benefits are categorized into several core areas. The quality of care is consistent across plans, but how you access that care—and what you pay out-of-pocket—varies significantly.

### Core Medical Benefits All TRICARE plans cover "medically necessary and appropriate" care. Key covered services include: * **Preventative Care:** Wellness exams, immunizations, and cancer screenings (often $0 out-of-pocket). * **Outpatient Care:** Office visits, urgent care, and specialist consultations. * **Inpatient Care:** Hospitalization, surgical services, and maternity care. * **Mental Health:** Therapeutic counseling, psychiatric care, and substance use disorder treatment. * **Pharmacy:** Managed by Express Scripts, providing maintenance medications via home delivery or acute medications at retail pharmacies.

### Benefit Differences by Plan (2026) As of 2026, the TRICARE landscape is managed by two regional contractors: **Humana Military** in the East and **TriWest Healthcare Alliance** in the West.

| Feature | TRICARE Prime | TRICARE Select | | :--- | :--- | :--- | | **Primary Care** | Assigned Primary Care Manager (PCM) | You choose any TRICARE-authorized provider | | **Referrals** | Required for specialists | Not required | | **Out-of-Pocket Costs** | Lowest; often $0 for Active Duty families | Annual deductible + cost-shares | | **Provider Network** | Military Hospitals or Network Providers | Network or Non-Network providers |

### 2026 Cost Factors Your benefits costs are dictated by your **Group**: * **Group A:** Sponsor enlisted/commissioned before Jan. 1, 2018. * **Group B:** Sponsor enlisted/commissioned on or after Jan. 1, 2018.

For 2026, Group A Retirees using TRICARE Select face an annual enrollment fee of approximately $375 per individual or $750 per family (verify exact 2026 adjustments at TRICARE.mil). Active Duty Family Members (ADFMs) on Prime generally pay $0 for in-network covered services.

### Pharmacy Benefits The TRICARE Pharmacy Program, managed by **Express Scripts**, categorizes drugs into three tiers: 1. **Generic:** Lowest cost. 2. **Brand Name (Formulary):** Moderate cost. 3. **Non-Formulary:** Highest cost. *Home Delivery remains the most cost-effective method for Tier 1 and Tier 2 maintenance medications.*

## Who this applies to * **Active Duty Service Members (ADSMs):** Receive full benefits with $0 out-of-pocket costs; must enroll in Prime. * **Active Duty Family Members (ADFMs):** Can choose between Prime ($0 premiums/copays in-network) or Select (deductibles and cost-shares apply). * **Retirees & Their Families:** Eligible for Prime or Select until age 65; higher cost-shares and enrollment fees apply compared to active duty. * **National Guard & Reserve:** Eligible for **TRICARE Reserve Select (TRS)**, a premium-based plan available to non-activated members. * **Medicare-Eligible Beneficiaries:** Transition to **TRICARE For Life (TFL)**, which acts as a secondary payer to Medicare Part A and B.

Common scenarios

**Scenario 1: Active Duty Spouse (East Region)** Sarah is an Active Duty spouse in Virginia (Group A). She is enrolled in TRICARE Prime. She visits her Primary Care Manager for a sinus infection and is referred to an ENT specialist. * **2026 Cost:** $0 out-of-pocket for both the PCM visit and the specialist, provided she obtained the referral.

**Scenario 2: Retired Family (West Region)** John retired in 2022 (Group B) and lives in Arizona. He and his wife use TRICARE Select. They visit a network doctor for a non-preventative issue. * **2026 Cost:** They must first meet their annual deductible (approx. $320-$350 for Group B). After the deductible, they pay a fixed copay per visit (e.g., $35-$45 for a primary care visit in 2026).

**Scenario 3: Filling a Prescription** A beneficiary fills a 90-day supply of a Tier 1 generic maintenance medication through Express Scripts Home Delivery. * **2026 Cost:** Typically $13–$15 (varies by plan year—check TRICARE.mil for current rates).

## Related terms * **Catastrophic Cap:** The maximum amount you will pay out-of-pocket for covered services each calendar year. * **Cost-Share:** The percentage of the total cost of a covered health care service you pay (common in TRICARE Select). * **Point-of-Service (POS) Option:** A feature of Prime that allows you to see non-network providers without a referral, but at much higher out-of-pocket costs. * **TRICARE-Authorized Provider:** A doctor or facility approved by TRICARE to provide care; can be "Network" or "Non-Network." * **DEERS:** The Defense Enrollment Eligibility Reporting System; you must be registered here to access benefits.

## Sources * **TRICARE.mil official benefits page:** https://www.tricare.mil/Benefits * **Humana Military (East Contractor):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West Contractor):** https://www.triwest.com/ * **Express Scripts TRICARE Pharmacy:** https://militaryrx.express-scripts.com/