TRICARE Plan Benefits: 2026 Coverage & Costs Guide | TRICARE.com

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## Quick answer TRICARE plan benefits provide comprehensive health coverage including primary care, specialty visits, hospitalization, and pharmacy services for military members and their families. While all plans cover the same "medically necessary" services, your out-of-pocket costs and how you access care (referrals vs. self-referrals) depend on whether you are in a Prime-type plan or a Select-type plan.

In detail

TRICARE benefits are standardized across the United States, though the administration of these benefits is split between **Humana Military** (East Region) and **TriWest Healthcare Alliance** (West Region).

### Core Covered Services Regardless of your specific plan, TRICARE covers services that are "medically necessary and appropriate." This includes: * **Preventive Care:** Annual physicals, immunizations, and cancer screenings (often $0 out-of-pocket). * **Outpatient Care:** Office visits, urgent care, and physical therapy. * **Inpatient Care:** Surgical procedures and hospital stays. * **Pharmacy:** Managed by Express Scripts, providing home delivery, retail, and military pharmacy options. * **Mental Health:** Inpatient and outpatient psychological services, including SUD (Substance Use Disorder) treatment.

### Comparing Key Plan Structures (2026) Plan benefits are generally categorized by how much control you have over your providers versus how much you pay.

| Benefit Feature | TRICARE Prime | TRICARE Select | | :--- | :--- | :--- | | **Primary Care** | Assigned Primary Care Manager (PCM) | You choose any TRICARE-authorized provider | | **Referrals** | Required for specialty care | Generally not required | | **Out-of-network** | Point of Service (POS) charges apply | Higher cost-shares than in-network | | **Annual Deductible** | None (for most) | Varies by rank and Group A/B status | | **Enrollment Fees** | Required for retirees | None for most (except Group B retirees) |

### 2026 Cost-Sharing Examples Costs are determined by the sponsor’s initial enlistment date (Group A vs. Group B). As of 2026: * **Active Duty Service Members (ADSMs):** $0 out-of-pocket for all covered care. * **Active Duty Family Members (Prime):** Typically $0 copays for covered services at network providers. * **Retirees (Select/Group B):** May face a network primary care copay of approximately $37–$40 per visit (varies by exact 2026 inflation adjustments; check TRICARE.mil for final 2026 rate tables).

### Pharmacy Benefits Managed by **Express Scripts**, the 2026 pharmacy benefit includes: * **Military Pharmacy:** $0 for a 90-day supply. * **Home Delivery:** Tier 1 (Generic) copays are approximately $13–$16 for a 90-day supply. * **Retail Network:** Tier 1 copays are approximately $16–$20 for a 30-day supply.

## Who this applies to * **Active Duty Service Members:** Must enroll in Prime; receive 100% coverage with no out-of-pocket costs. * **Active Duty Family Members:** Choose between Prime (managed care) or Select (freedom of choice). * **National Guard & Reserve:** Eligible for TRICARE Reserve Select (TRS) while in a non-activated status. * **Retirees and Families:** Can use Prime (where available) or Select; subject to annual enrollment fees and higher cost-shares. * **Young Adult Children:** Eligible for TRICARE Young Adult (TYA) up to age 26 if not married or eligible for employer-sponsored care.

Common scenarios

**Scenario 1: The Active Duty Spouse (Select)** Sarah is an Army spouse in the TRICARE West region (managed by TriWest). She uses TRICARE Select because she prefers a civilian OBGYN. In 2026, she pays no enrollment fee. When she visits her doctor, she pays a negotiated cost-share (roughly $30–$40) because her deductible has been met, but she does not need a referral from a military PCM.

**Scenario 2: The Retired Veteran (Prime)** Mark retired in 2022 (Group B). He lives in the East region (managed by Humana Military) and is enrolled in TRICARE Prime. For 2026, he pays an annual enrollment fee (approx. $390+ for an individual). Because he stays within the Prime network and gets referrals for his physical therapy, his individual copays are low (approx. $25 per visit).

**Scenario 3: The Pharmacy Switch** A beneficiary needs a maintenance medication. If they go to a CVS or Walgreens (Retail), they pay a ~$16 copay for 30 days. By switching to Express Scripts Home Delivery, they pay ~$16 for a 90-day supply, saving roughly $32 every three months.

## Related terms * **Catastrophic Cap:** The maximum out-of-pocket amount a family pays per calendar year for covered services. * **Cost-Share:** The percentage of the total cost of a covered health care service you pay (common in Select). * **Point of Service (POS):** An option in Prime to see a non-network provider without a referral, resulting in significantly higher costs. * **TRICARE Authorized Provider:** A doctor or facility approved by TRICARE to provide care; they can be "Network" or "Non-Network." * **Qualifying Life Event (QLE):** A change like marriage, birth, or PCS that allows you to change your plan outside of Open Season.

## Sources * TRICARE.mil Plan Finder: https://www.tricare.mil/Plans/HealthPlans * Defense Health Agency (DHA) Cost Sheets: https://www.tricare.mil/costs * Humana Military (East): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West): https://www.triwest.com/pv