TRICARE Providers Guide: Network vs. Non-Network Costs
*TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and the most up-to-date information, visit TRICARE.mil.*
## Quick answer TRICARE providers are healthcare professionals or facilities authorized by the Defense Health Agency (DHA) to provide care to service members and their families. Depending on your plan, you will see either **Network** providers (who have a contract with Humana Military or TriWest), **Non-Network** providers (who are authorized but don't have a contract), or **Military Providers** at a Military Medical Treatment Facility (MTF).
In detail
To receive covered care under TRICARE, your doctor or hospital must be "TRICARE-authorized." If they are not authorized, TRICARE will not pay your claim, and you will be responsible for the entire bill.
### 1. Network Providers Network providers have signed an agreement with the regional contractors (Humana Military in the East or TriWest in the West). * **Benefits:** They handle all paperwork and file claims for you. They agree to charge a pre-negotiated rate. * **Cost-Share:** Usually results in the lowest out-of-pocket costs (e.g., for TRICARE Select, a 2026 network primary care visit may be as low as $39 for Group A retirees, whereas non-network is higher). * **Plans:** Required for TRICARE Prime (Primary Care Manager assignment).
### 2. Non-Network Providers These are authorized providers who do not have a formal contract with TRICARE. They fall into two sub-categories: * **Participating:** They agree to file claims for you and accept the "TRICARE Allowable Charge" as payment in full. * **Non-Participating:** They do not file claims and can charge up to 15% above the TRICARE Allowable Charge. You pay the provider upfront and file for reimbursement later.
### 3. Military Providers (MTFs) These providers work directly for the Department of Defense. * **Availability:** Priority is given to Active Duty Service Members (ADSMs) and TRICARE Prime enrollees. * **Cost:** Generally $0 for most services provided within the facility.
Provider Comparison Table (2026)
| Feature | Network Provider | Non-Network (Participating) | Non-Network (Non-Participating) | | :--- | :--- | :--- | :--- | | **Files Claims?** | Yes | Yes | No (You file) | | **Accepts TRICARE Rate?** | Yes | Yes | No (Up to 15% extra) | | **Out-of-Pocket Cost** | Lowest | Moderate | Highest | | **Referral Required?** | Yes (for Prime) | Yes (for Prime) | Yes (for Prime) |
### Regional Contractors (T-5 Contract) As of 2026, the provider networks are managed by: * **East Region:** Humana Military. * **West Region:** TriWest Healthcare Alliance. * **Overseas:** International SOS.
## Who this applies to * **Active Duty Service Members:** Restricted almost exclusively to Military Providers or specific Network referrals through TRICARE Prime. * **Active Duty Family Members:** Can choose between Network (Prime) or Non-Network (Select) depending on their enrollment choice. * **Retirees and their Families:** Impacted most by cost-share differences between Network and Non-Network providers. * **TRICARE Reserve Select/Retired Reserve:** These beneficiaries have the flexibility to see any authorized provider but save significantly by using Network providers.
Common scenarios
**Scenario 1: Using a Network Provider (TRICARE Select)** Jane is a Navy spouse on TRICARE Select in the East Region. She visits a Network dermatologist in 2026 for a skin check. The provider bills $200, but the TRICARE contracted rate is $140. Jane pays her fixed copayment (e.g., $53 for a specialist visit in 2026 for Group A) and the provider bills Humana Military for the rest. Jane has no further paperwork.
**Scenario 2: Using a Non-Participating Provider** Mark is a retired Army officer using TRICARE Select. He visits a non-network, non-participating therapist. The TRICARE allowable charge is $100. Because the provider is non-participating, they charge Mark the "limiting charge" of $115 (15% extra). Mark pays the full $115 out of pocket at the office and must manually file a claim with TriWest to be reimbursed his portion of the $100 allowable charge.
## Related terms * **Authorized Provider:** A doctor, hospital, or specialist that meets TRICARE's licensing and certification requirements. * **Primary Care Manager (PCM):** The specific provider responsible for your care and referrals under a TRICARE Prime plan. * **TRICARE Allowable Charge:** The maximum amount TRICARE will pay for a specific medical service. * **Point-of-Service (POS) Option:** An expensive option for Prime enrollees to see a non-network provider without a referral. * **Balance Billing:** When a non-participating provider charges you the difference between their fee and the TRICARE allowable charge (limited to 15%).
## Sources * TRICARE.mil - Types of Providers: https://www.tricare.mil/Providers/Types * Humana Military (East Region): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West Region): https://www.triwest.com/ * TRICARE.mil - Find a Doctor: https://www.tricare.mil/findaprovider