TRICARE Second Opinion: Coverage, Rules, and 2026 Costs | TRICARE.com

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## Quick answer TRICARE typically covers second opinions if your doctor or your regional contractor determines they are medically necessary for a diagnosed condition. Active duty service members (ADSMs) always require a referral from their Primary Care Manager, while TRICARE Select users can generally seek a second opinion from any TRICARE-authorized provider without a specific referral, though they will pay standard cost-shares.

Details

### Referral Requirements by Plan The process for getting a second opinion depends heavily on your TRICARE plan and your status.

* **TRICARE Prime (and Prime Remote):** You must get a referral from your Primary Care Manager (PCM). This referral must then be authorized by your regional contractor (Humana Military in the East or TriWest in the West). If you seek a second opinion without this authorization, you will likely be charged under the **Point-of-Service (POS) option**, which includes a high deductible and 50% cost-sharing. * **TRICARE Select:** You do not need a referral for a second opinion as long as you see a TRICARE-authorized provider. However, using a network provider will result in lower out-of-pocket costs than using a non-network provider. * **Active Duty Service Members (ADSM):** You are required to have a referral for all specialty care, including second opinions. These are usually coordinated through your military hospital or clinic.

### Medical Necessity and Coverage TRICARE covers second opinions for: 1. Confirming a diagnosis. 2. Evaluating a proposed treatment plan or surgery. 3. Situations where the initial diagnosis is unclear.

If the second opinion differs significantly from the first, TRICARE may also cover a **third opinion**.

### Costs and Fees (2026 Rates) If the second opinion is authorized or if you are using TRICARE Select, your costs follow the standard specialty care rates for 2026: * **Active Duty Family Members (Prime):** $0 out-of-pocket for authorized referrals. * **Retirees (Prime):** Approximately $38–$40 per visit (varies by Group A/B status; check TRICARE.mil for exact 2026 tiers). * **TRICARE Select (Group A Retirees):** Network specialty visits typically cost approximately $50–$55 in 2026.

### Travel Reimbursement TRICARE does not generally pay for travel to get a second opinion unless the referral meets the criteria for the Prime Travel Benefit (typically requiring travel over 100 miles from your PCM’s office for a specific medical necessity not available locally).

## Who this affects * **Active Duty Service Members:** Requires PCM referral and military medical officer oversight. * **Active Duty Family Members:** Prime members need referrals; Select members do not. * **Retirees and their Families:** Subject to 2026 enrollment fees and copayments. * **Guard/Reserve (Select/TRS):** Generally follows TRICARE Select rules (no referral needed for network providers).

## Sources * **TRICARE.mil:** [Referrals and Authorizations](https://www.tricare.mil/referrals) * **Humana Military (East):** [Seeking a Second Opinion](https://www.humanamilitary.com/beneficiary/specialty-care) * **TriWest Healthcare Alliance (West):** [Provider Requirements](https://www.triwest.com) * **TRICARE.mil:** [Cost Terms](https://www.tricare.mil/Costs/Cost-Terms)