TRICARE Out-of-Network Coverage: Costs & Rules (2026) | TRICARE.com

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## Quick answer Whether TRICARE covers out-of-network care depends entirely on your specific plan. TRICARE Prime generally requires a referral and carries high "point-of-service" fees for out-of-network care, while TRICARE Select offers the most flexibility to see any provider but results in higher out-of-pocket costs than seeing a network provider.

Details

### TRICARE Select and Out-of-Network Doctors TRICARE Select is a preferred provider organization (PPO) style plan. You do not need a referral for most services. While you save the most money using "Network" providers, you are permitted to see "Non-Network" providers.

Non-network providers fall into two categories: 1. **Participating:** They do not have a formal contract with TRICARE but agree to file claims for you and accept the TRICARE-allowable charge as payment in full. 2. **Non-Participating:** They do not agree to TRICARE's rates and may charge you up to 15% above the TRICARE-allowable amount. This is known as a "balance bill."

**2026 Costs for Select:** For Group A retirees, the out-of-network outpatient deductible is approximately $150 per individual, with cost-shares around 25% of the allowable charge (check TRICARE.mil for specific 2026 tier updates).

### TRICARE Prime and Point-of-Service (POS) TRICARE Prime is similar to an HMO. If you see an out-of-network provider without a formal referral from your Primary Care Manager (PCM) and authorization from your regional contractor (Humana Military or TriWest), you will be charged under the **Point-of-Service (POS) option**.

The POS option is expensive. For 2026, POS fees typically include: * **Deductible:** $300 for individuals / $600 for families. * **Cost-Share:** 50% of the TRICARE-allowable charge. * **Exclusions:** POS charges do not apply toward your annual Catastrophic Cap.

### Active Duty Service Members (ADSMs) Active duty members have **no** out-of-network coverage unless it is an emergency or they have a specific waiver/referral. ADSMs must receive all care from military hospitals or clinics unless coordinated through the TRICARE Prime Remote program or via a supplemental care authorization.

### Mental Health Edge Case In many regions, TRICARE allows beneficiaries to see certain non-network mental health providers without a referral, though Select cost-shares or Prime POS fees will still apply. Always verify with TriWest (West) or Humana Military (East) before your first session.

## Who this affects * **Active Duty Family Members (ADFMs):** High impact; must choose between the restrictions of Prime or the higher costs of Select. * **Retirees and their Families:** High impact; navigating out-of-network costs is a primary factor in choosing between Select and Prime. * **TRICARE Reserve Select (TRS) Users:** Impacted; TRS functions like Select, allowing out-of-network care at higher cost-shares. * **Active Duty Service Members:** Minimal impact; rarely permitted to go out-of-network.

## Sources * **TRICARE.mil:** [Using Out-of-Network Providers](https://www.tricare.mil/FindDoctor/AllProviderList/OutOfNetwork) * **TRICARE.mil:** [Point-of-Service Option](https://www.tricare.mil/Costs/HealthPlanCosts/PrimeOptions/POS) * **Humana Military (East):** [Provider Network Information](https://www.humanamilitary.com/) * **TriWest Healthcare Alliance (West):** [Network Provider Search](https://www.triwest.com/)