TRICARE Guide 2026: Plans, Costs, and Eligibility

*TRICARE.com is an independent reference site and is not the official TRICARE program or the Department of Defense. For official policy and the most up-to-date program information, visit TRICARE.mil.*

## Quick answer TRICARE is the health insurance program for uniformed service members, retirees, and their families worldwide. It combines military hospitals and clinics with networks of civilian providers to provide comprehensive medical, dental, and pharmacy coverage. The program is managed by the Defense Health Agency (DHA) and utilizes regional contractors—Humana Military in the East and TriWest Healthcare Alliance in the West—to coordinate care.

In detail

TRICARE is structured into several different plans based on your status (active duty, retired, Guard/Reserve) and where you live. As of 2026, the program operates under the T-5 contract, focusing on improved provider networks and streamlined digital services.

### Core TRICARE Plans * **TRICARE Prime:** Similar to an HMO. You have a Primary Care Manager (PCM) who coordinates all care. Active Duty Service Members (ADSMs) must enroll in Prime. There are no out-of-pocket costs for active duty families when using network providers. * **TRICARE Select:** Similar to a PPO. You can see any TRICARE-authorized provider without a referral. You pay an annual deductible and cost-shares (a percentage of the cost). * **TRICARE For Life (TFL):** Wrap-around coverage for those entitled to Medicare Part A and Part B. TFL acts as the secondary payer to Medicare. * **TRICARE Reserve Select (TRS):** A premium-based plan for qualified Select Reserve members and their families. * **TRICARE Retired Reserve (TRR):** A premium-based plan for retired Reserve members under age 60.

### Regional Management (2026 Structure) The United States is divided into two regions. Your contractor handles your enrollment, claims processing, and provider directories: * **East Region:** Managed by **Humana Military**. * **West Region:** Managed by **TriWest Healthcare Alliance** (transitioned from Health Net in 2025). * **Overseas:** Managed by **International SOS**.

### 2026 Costs and Fees Costs are divided into two Groups: * **Group A:** Sponsor’s initial enlistment or appointment was before Jan. 1, 2018. * **Group B:** Sponsor’s initial enlistment or appointment was on or after Jan. 1, 2018.

*Note: Active duty members and their families on Prime have $0 out-of-pocket costs for covered services.*

### Pharmacy Benefits Prescription coverage is managed by **Express Scripts**. You can fill prescriptions at Military Pharmacies ($0), via Home Delivery, or at retail network pharmacies (highest co-pay).

## Who this applies to * **Active Duty Service Members (ADSMs):** Mandatory enrollment in Prime; $0 out-of-pocket costs. * **Active Duty Family Members (ADFMs):** Can choose between Prime (no cost) or Select (deductibles apply). * **Military Retirees and Families:** Must pay annual enrollment fees and cost-shares for care. * **National Guard & Reserve:** Eligible for TRS while in drilling status or TRR after retirement but before age 60. * **Medal of Honor Recipients:** And their eligible family members.

Common scenarios

**The Active Duty Family (Prime)** Staff Sergeant Miller is stationed at Fort Liberty. His wife and two children are enrolled in **TRICARE Prime**. They see a PCM at the MTF on base. When the daughter needs a dermatologist, the PCM provides a referral. Total out-of-pocket cost for the visit and the prescription: **$0**.

**The Retired Couple (Select)** Major Brooks (retired in 2015, Group A) lives in the West Region. He and his wife prefer civilian doctors and use **TRICARE Select**. In 2026, they pay an annual enrollment fee (approx. $380-$400). When Major Brooks visits a network specialist, he pays a $50 co-pay after meeting his $150 individual deductible.

**The Guard Member (Reserve Select)** Sgt. Chen is a drilling member of the Army National Guard. She pays a monthly premium (roughly $55-$65 for individual coverage in 2026) for **TRICARE Reserve Select**. She sees a local civilian doctor and pays a 15% cost-share for her annual physical.

## Related terms * **DEERS:** The Defense Enrollment Eligibility Reporting System; the database that determines TRICARE eligibility. * **MTF:** Military Treatment Facility; a hospital or clinic located on a military base. * **Catastrophic Cap:** The maximum out-of-pocket amount a family will pay for covered services in a calendar year. * **Point of Service (POS):** An option in Prime to see a non-network provider without a referral, resulting in significantly higher costs. * **T-5 Contract:** The fifth generation of TRICARE managed care support contracts, which took full effect Jan 1, 2025.

## Sources * TRICARE Official Site: https://www.tricare.mil * Defense Health Agency (DHA): https://health.mil * Humana Military (East): https://www.humanamilitary.com * TriWest Healthcare Alliance (West): https://www.triwest.com