Civilian Hospitals and TRICARE: Costs, Rules & Referrals | TRICARE.com

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## Quick answer Most TRICARE beneficiaries can receive care at civilian hospitals, but your access depends on your plan and the type of care needed. While TRICARE Prime usually requires a referral to a military hospital first, TRICARE Select allows you to visit any TRICARE-authorized civilian hospital, though using network facilities will significantly lower your out-of-pocket costs.

Details

### Emergency Care at Civilian Hospitals In a true medical emergency, TRICARE covers care at the nearest civilian hospital emergency room. You do not need prior authorization to seek life-saving care. However, once the emergency is stabilized, TRICARE may require you to be transferred to a military treatment facility (MTF) if a bed is available. You must notify your regional contractor (Humana Military in the East or TriWest in the West) within 24 hours of any civilian emergency admission.

### TRICARE Prime vs. TRICARE Select How you access civilian hospitals differs by plan: * **TRICARE Prime:** You are generally required to seek care at an MTF first. If the MTF cannot provide the service, your Primary Care Manager (PCM) will issue a referral to a civilian hospital. If you go to a civilian hospital without a referral (non-emergency), you will be charged under the **Point-of-Service (POS)** option, which includes a high deductible and 50% cost-sharing. * **TRICARE Select:** You have the freedom to choose any civilian hospital. However, cost-sharing is higher at "Non-Network" hospitals compared to "Network" hospitals.

### 2026 Costs and Copays Costs at civilian hospitals depend on your "Group" status (Group A joined before 2018; Group B joined after) and your sponsor's status. As of 2026, typical network civilian hospital costs include: * **Active Duty Family Members (Prime):** $0 copay for authorized civilian inpatient stays. * **Retirees (Select/Group A):** Varies by plan year—check TRICARE.mil for current rates (typically a fixed per-diem or a percentage of the allowed amount). * **Catastrophic Cap:** All civilian hospital charges count toward your annual catastrophic cap, protecting you from extreme financial loss.

### The Role of Regional Contractors Civilian hospital claims and authorizations are managed by regional contractors. As of 2025/2026: * **East Region:** Managed by **Humana Military**. * **West Region:** Managed by **TriWest Healthcare Alliance**.

If a civilian hospital is "non-authorized," TRICARE will not pay the claim, and you will be responsible for the full bill. Always verify a hospital's status via the contractor’s provider directory before elective procedures.

## Who this affects * **Active Duty Service Members:** Always need a referral/authorization for non-emergency civilian care. * **Active Duty Family Members:** Can use civilian hospitals via Prime (with referral) or Select (self-refer). * **Retirees and their Families:** High users of civilian networks, especially those not living near a military base. * **National Guard and Reserve:** Use civilian hospitals through TRICARE Reserve Select (TRS). * **TRICARE For Life (TFL) beneficiaries:** Use civilian hospitals that accept Medicare and TRICARE.

## Sources * **TRICARE.mil:** [Using Out-of-Network Providers](https://www.tricare.mil/FindDoctor/AllProviderDirectories/NonNetwork) * **Humana Military (East):** [Provider Search and Hospital Network](https://www.humanamilitary.com/beneficiary) * **TriWest Healthcare Alliance (West):** [West Region Provider Directory](https://www.triwest.com/en/beneficiary/) * **Defense Health Agency (DHA):** [TRICARE Plans Overview](https://health.mil/)