TRICARE Org Guide: Understanding the System Structure
*TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy, please visit TRICARE.mil.*
## Quick answer In the context of military healthcare, "the Org" usually refers to the **Defense Health Agency (DHA)** or the specific **Military Treatment Facility (MTF)** organizational structure. At a system-wide level, it represents the unified medical command that manages TRICARE, overseeing both the direct care system (military hospitals) and the purchased care system (civilian networks like Humana Military and TriWest).
## In detail Understanding the organizational hierarchy of TRICARE is essential for navigating benefits and resolving claims. As of 2026, the structure is divided into three primary layers: the policy-makers, the regional contractors, and the providers.
### 1. The Defense Health Agency (DHA) The DHA is the central "Org" that manages the TRICARE Health Plan. They set the rules for what is covered, how much beneficiaries pay, and how the regional contractors must behave. They also oversee the military hospitals and clinics (Direct Care).
### 2. Regional Contractors (The T-5 Contract) Under the current T-5 contract (effective January 2025 and continuing through 2026), the U.S. is divided into two major organizational regions: * **TRICARE East:** Managed by **Humana Military**. * **TRICARE West:** Managed by **TriWest Healthcare Alliance** (which replaced Health Net Federal Services).
### 3. Service-Specific Organizations While the DHA manages the benefit, your specific branch of service (Army, Navy, Air Force) organizes the personnel and the "Readiness" aspect of the medical system. This is why active duty members are often assigned to a specific "Org" within a Military Treatment Facility (MTF).
### Cost Share Comparison (2026 Rates - Sample) Fees are often determined by the organizational status (Group A vs. Group B) of the beneficiary.
| Service/Item | TRICARE Prime (Active Duty Family) | TRICARE Select (Group A Retiree) | | :--- | :--- | :--- | | **Annual Enrollment** | $0 | ~$384 (Individual) / ~$769 (Family) | | **PCP Visit** | $0 | ~$38 | | **Specialist Visit** | $0 | ~$52 | | **ER Visit** | $0 | ~$180 |
*Note: Group A includes those who entered service before Jan 1, 2018. Group B includes those who entered after.*
## Who this applies to * **Active Duty Service Members (ADSMs):** Must follow the MTF organizational structure and require 100% "Org" approval (referrals) for civilian care. * **Active Duty Family Members (ADFMs):** Impacted by regional organizational rules regarding Prime vs. Select enrollment. * **Retirees and Families:** Must navigate the organization of the TRICARE West or East contractors for claims and enrollment. * **Guard/Reserve:** Must interact with the "Org" (DHA) through TRICARE Reserve Select (TRS) for monthly premium-based coverage.
Common scenarios
### 1. The Regional Move Sgt. Miller moves from Florida (East Region) to California (West Region). He must contact the new "Org" (TriWest Healthcare Alliance) to transfer his Prime enrollment. Because he is Group A, his enrollment is seamless, but his primary care manager organization changes from a civilian network to a military clinic.
### 2. Specialty Referral Jane, a retiree spouse in the East Region (Group B), needs a neurology consult. Because she is on TRICARE Select, she doesn't need "Org" approval (a referral) to see a network specialist, but she will pay a 2026 copay of roughly $50 per visit to the Humana Military network provider.
### 3. Pharmacy Management Chief Petty Officer Grant needs a maintenance medication. He interacts with the pharmacy "Org," **Express Scripts**. By using the TRICARE Mail Order Pharmacy, he pays significantly less ($16 for a 90-day generic supply) than at a retail pharmacy ($43).
## Related terms * **DHA (Defense Health Agency):** The joint-service agency that manages the TRICARE program. * **T-5 Contract:** The current set of regional contracts that started in 2025, defining how Humana and TriWest operate. * **MTF (Military Treatment Facility):** Military-run hospitals or clinics located on bases. * **PCM (Primary Care Manager):** The specific provider or "Org" clinic assigned to manage a Prime member's care. * **Sponsor:** The active duty or retired service member through whom the family receives TRICARE.
## Sources * **TRICARE.mil:** Official site for benefit information. [https://www.tricare.mil](https://www.tricare.mil) * **Defense Health Agency:** Information on the T-5 contract and oversight. [https://health.mil](https://health.mil) * **Humana Military:** East Region contractor site. [https://www.humanamilitary.com](https://www.humanamilitary.com) * **TriWest Healthcare Alliance:** West Region contractor site. [https://www.triwest.com](https://www.triwest.com)