TriWest Healthcare Alliance: TRICARE West Guide | TRICARE.com

Everything TRICARE beneficiaries need to know about TriWest Healthcare Alliance, the West Region contractor, including 2026 coverage, claims, and contact info.

TriWest Healthcare Alliance: TRICARE West Guide

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## Quick answer TriWest Healthcare Alliance is the official managed care contractor for the **TRICARE West Region**. Since January 1, 2025, TriWest has been responsible for managing provider networks, processing claims, and providing customer service for military families in 26 western states. If you live in the West Region and use TRICARE Prime or Select, TriWest is the company that coordinates your off-base care and handles your medical billing.

## In detail As the "T-5" (fifth generation) contract recipient, TriWest Healthcare Alliance oversees the healthcare delivery system for millions of beneficiaries. Their role is to bridge the gap between military treatment facilities (MTFs) and the civilian "purchased care" network.

### Geographic Coverage TriWest manages the West Region, which currently includes: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except Rock Island area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas (western areas/El Paso), Utah, Washington, and Wyoming.

*Note: Several states previously in the East Region moved to the West Region on January 1, 2025, including Arkansas, Illinois, Louisiana, Oklahoma, and Texas.*

### Primary Responsibilities * **Network Management:** Recruiting and contracting with civilian doctors, hospitals, and specialists. * **Referrals and Authorizations:** Reviewing requests from PCMs for West Region beneficiaries to see specialists. * **Claims Processing:** Paying civilian providers for covered services. * **Customer Service:** Operating call centers for enrollment and benefit questions.

### 2026 Plan Year Impact Under the current T-5 contract, TriWest focuses on digital integration. Beneficiaries must use the TriWest portal for: * Checking the status of an authorization. * Paying monthly premiums (for TRICARE Reserve Select or Young Adult). * Searching the "Find a Doctor" directory.

**Cost Shares (2026 Rates for Group A):** * **TRICARE Prime:** $0 for active duty; Retirees pay approximately $38 per specialist visit (varies by specific plan year — check TRICARE.mil for current rates). * **TRICARE Select:** Most outpatient visits for retirees involve a $30–$40 copay when using TriWest’s preferred providers.

## Who this applies to * **Active Duty Service Members (ADSMs):** Those stationed in the West Region use TriWest for any care received outside of a military clinic. * **Active Duty Family Members (ADFMs):** Those living in the West Region who need referrals to civilian specialists or use TRICARE Select. * **Retirees and Families:** Retirees in the West Region pay their annual enrollment fees to TriWest and use their network for civilian care. * **National Guard and Reserve:** For those enrolled in TRICARE Reserve Select (TRS) living in the West Region, TriWest processes all claims and manages premium billing.

Common scenarios

**The Referral Process** Jane is an Active Duty spouse in San Diego (West Region) enrolled in TRICARE Prime. Her military doctor refers her to a civilian dermatologist. TriWest reviews the referral. Within 3–5 days, Jane logs into the TriWest portal to see the approved authorization and the name of the civilian specialist. Because she is Active Duty and used an authorized provider, her out-of-pocket cost is **$0**.

**The New Retiree** Mark retires in 2026 and moves to Phoenix, Arizona. He selects TRICARE Select. He visits a TriWest network cardiologist for a checkup. Because he is a Group A retiree, he pays a negotiated copay (e.g., $38 for 2026) directly to the doctor, and the doctor files the remaining claim with TriWest.

**Relocating from the East** Sgt. Smith moves from Fort Bragg (East - Humana) to Joint Base Lewis-McChord (West - TriWest). He must update his address in DEERS and contact TriWest to ensure his enrollment is transferred to the West Region contractor to avoid a gap in coverage.

## Related terms * **T-5 Contract:** The fifth generation of TRICARE managed care contracts that began implementation in 2025. * **Region East:** The geographic half of the U.S. managed by Humana Military. * **Network Provider:** A civilian doctor who has a formal agreement with TriWest to provide care at pre-negotiated rates. * **DEERS:** The Defense Enrollment Eligibility Reporting System; you must be show as eligible here before TriWest can process your claims. * **Point of Service (POS):** An option where Prime enrollees can see any doctor without a referral, but at a much higher cost (typically a $300 deductible).

## Sources * **TRICARE.mil official contractor list:** [https://www.tricare.mil/About/Contractors](https://www.tricare.mil/About/Contractors) * **TriWest TRICARE West portal:** [https://www.triwest.com/tricare](https://www.triwest.com/tricare) * **Defense Health Agency (DHA):** [https://health.mil/](https://health.mil/)