TriWest Healthcare Alliance: TRICARE West Region Guide | TRICARE.com

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## Quick answer As of January 1, 2025, **TriWest Healthcare Alliance** is the sole managed care contractor for the TRICARE West Region. If you live in one of the 26 western U.S. states, TriWest administers your provider network, processes your medical claims, and handles your customer service. They replaced Health Net Federal Services (HNFS) under the current T-5 contract cycle.

In detail

The transition to TriWest Healthcare Alliance marked a significant shift in the TRICARE landscape. Under the T-5 contract, the geographic boundaries changed, and TriWest took over a territory that includes approximately 4.5 million beneficiaries.

### Geographic Coverage TriWest manages the **West Region**, which includes: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Minnesota, Missouri (excluding the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas (parts of Western/Northern Texas), Utah, Washington, and Wyoming.

*Note: Arkansas and several Illinois counties were moved to the East Region during the 2025 transition.*

### Key Responsibilities * **Provider Network:** TriWest maintains the directory of "Prime" and "Select" civilian providers. * **Referrals and Authorizations:** If you are on TRICARE Prime, TriWest processes the requests from your doctor to see a specialist. * **Claims Processing:** They handle the billing between your doctor and the government. * **Customer Service:** Running the regional call centers and online portals for enrollment and billing.

### 2026 Costs and Fees Costs are determined by your plan and "Group" status (Group A joined before 2018; Group B joined after), not by the contractor. However, TriWest is responsible for collecting these 2026 rates for West Region beneficiaries:

| Plan Type | Enrollment Fee (Retirees - Group A) | Annual Deductible (Network) | PCP Copay (Network) | | :--- | :--- | :--- | :--- | | **TRICARE Prime** | ~$391/individual (2026) | $0 | $0 | | **TRICARE Select** | ~$195/individual (2026) | $193 (Active Duty Family) | $32 - $35 |

*Note: Active duty service members always have $0 out-of-pocket costs for covered care.*

## Who this applies to * **Active Duty Service Members (ADSMs):** Living in the West Region, you interact with TriWest for any care received outside of a Military Hospital or Clinic. * **Active Duty Family Members (ADFMs):** Whether on Prime or Select, your network of doctors is managed by TriWest. * **Retirees and their Families:** Those under age 65 living in the West Region use TriWest until they transition to TRICARE For Life (Medicare). * **National Guard and Reserve:** Members using TRICARE Reserve Select (TRS) in the 26 western states.

Common scenarios

### Scenario 1: A Referral in San Diego Jane is an Active Duty spouse in San Diego on **TRICARE Prime**. Her Primary Care Manager (PCM) determines she needs to see a cardiologist. The PCM submits a request to **TriWest**. Within 2-5 days, Jane logs into the TriWest portal to view her authorization letter, which directs her to a specific network specialist. Because she stays in-network, her 2026 copay is **$0**.

### Scenario 2: A Retiree in Phoenix Mark is a retired veteran on **TRICARE Select** in Phoenix. He visits a network dermatologist without a referral. Under 2026 Select rates for Group A retirees, Mark is responsible for his annual deductible (approx. $193) and then a copay of roughly **$55 per specialist visit**. TriWest processes the claim and sends Mark an Explanation of Benefits (EOB).

### Scenario 3: Moving from East to West Sgt. Smith moves from Fort Bragg (East - Humana Military) to Fort Lewis (West - TriWest). Because the contractors are different, Sgt. Smith must ensure his enrollment is transferred to the West Region. While his benefits remain the same, his "home" contractor for claims and authorizations switches to **TriWest**.

## Related terms * **T-5 Contract:** The fifth generation of TRICARE contracts which officially began full operations on January 1, 2025. * **Network Provider:** A doctor or hospital that has a formal agreement with TriWest to provide care at discounted rates. * **Point of Service (POS):** An option for Prime enrollees to see any provider without a referral, resulting in much higher out-of-pocket costs. * **Defense Enrollment Eligibility Reporting System (DEERS):** The database where you must update your address before TriWest can recognize you in their region. * **Explanation of Benefits (EOB):** The document TriWest sends you explaining what they paid to a doctor and what you owe.

## Sources * **TRICARE.mil - West Region:** https://www.tricare.mil/west * **TriWest Healthcare Alliance Official Site:** https://www.triwest.com/ * **Defense Health Agency (DHA) - T-5 Transition:** https://health.mil/Military-Health-Topics/Business-Support/Partnering-with-the-DHA/T5-Contract-Awards