What are my TRICARE out-of-network benefits?

Direct answer: You still have coverage with a TRICARE-authorized non-network provider, but you'll pay more and may have to file the claim yourself — seeing a provider who isn't TRICARE-authorized at all means you're responsible for the full cost.

Applies to: All TRICARE plans · All regions

Details

There are two kinds of authorized non-network providers. A participating non-network provider accepts TRICARE’s allowable charge as full payment, files your claim, and collects only your cost-share at the visit. A nonparticipating non-network provider can bill up to 15% above the allowable charge, usually wants payment upfront, and leaves you to file the claim and absorb any amount above the allowable charge yourself. Active-duty service members have no out-of-pocket costs; costs for retirees and family members vary by plan.

What to do next

Confirm this with your Primary Care Manager or regional contractor before scheduling — rules can vary by region and by service.