TRICARE Specialist Costs: 2026 Rates & Referral Rules
## Quick answer Specialist costs depend on your TRICARE plan and beneficiary category. Active duty service members always pay $0, while family members and retirees typically pay between $30 and $70 per visit for TRICARE Prime or Select, provided they follow referral rules.
## Details *Note: TRICARE.com is an independent reference site and is not the official TRICARE program or a government agency. For official policy and real-time updates, visit TRICARE.mil.*
Your out-of-pocket costs for a specialist (such as a cardiologist, dermatologist, or orthopedist) are determined by your "Group" status. Group A includes those who entered service before January 1, 2018. Group B includes those who entered on or after that date.
### TRICARE Prime (All Versions) TRICARE Prime is a managed care option. To see a specialist, you generally must obtain a referral from your Primary Care Manager (PCM). * **Active Duty Service Members (ADSMs):** $0 for all authorized specialist care. * **Active Duty Family Members (ADFMs):** $0 for authorized specialist care (Group A and B). * **Retirees and Others:** For 2026, the copayment for an in-network specialist visit is approximately **$39 to $42** (varies slightly by Group; check TRICARE.mil for the exact 2026 inflation-adjusted figures).
**The Point-of-Service (POS) Warning:** If you see a specialist without a referral under TRICARE Prime, you will be charged under the Point-of-Service option. This includes a $300 deductible and a 50% cost-share of the TRICARE-allowable charge.
### TRICARE Select TRICARE Select is a PPO-style plan. You do not need a referral for most specialists, though you must meet your annual deductible first. * **ADFMs (Group A):** Approximately **$30–$35** per visit (2026 rates) when using an in-network provider. * **ADFMs (Group B):** Approximately **$32–$38** per visit (2026 rates). * **Retirees (Group A):** Approximately **$55–$65** per visit (2026 rates). * **Retirees (Group B):** Approximately **$60–$75** per visit (2026 rates).
### Regional Contractors and Networks Costs are standard across regions, but the network of available specialists is managed by specific contractors: * **East Region:** Humana Military. * **West Region:** TriWest Healthcare Alliance (as of January 1, 2025). Using an "out-of-network" specialist under TRICARE Select significantly increases your costs, often involving a 20% to 25% cost-share of the total bill.
## Who this affects * **Active Duty Service Members:** Always $0, but requires a referral. * **Active Duty Family Members:** Costs vary by plan; Prime is usually $0. * **Retirees & Families:** Pay copayments for all specialist visits. * **National Guard & Reserve:** Coverage depends on being in "active" status or enrolled in TRICARE Reserve Select. * **Survivors:** Costs reflect the status of the sponsor's category at the time of the event.
## Sources * **TRICARE.mil - Cost Comparison Tool:** https://www.tricare.mil/costs/compare * **Humana Military (East):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West):** https://www.triwest.com/ * **Defense Health Agency (DHA):** https://health.mil/