TRICARE Mental Health Referral Requirements & Costs (2026)

*TRICARE.com is an independent reference site and is not a government agency. For official policy and enrollment, visit TRICARE.mil.*

## Quick answer Most TRICARE beneficiaries (family members and retirees) can visit an in-network mental health provider for outpatient therapy without a referral or prior authorization. Active duty service members (ADSMs) are the exception; they require a referral from their primary care manager (PCM) for all mental health care sought outside of a military clinic.

Details

### Outpatient Therapy (No Referral Needed) Under current TRICARE policy, non-active duty beneficiaries using **TRICARE Prime**, **TRICARE Select**, **TRICARE Reserve Select**, or **TRICARE For Life** do not need a referral for medically necessary outpatient mental health visits with an authorized in-network provider. This includes: * Individual therapy sessions. * Family or group therapy. * Diagnostic evaluations.

While no referral is needed, ensure the provider is "TRICARE-authorized." If you use an out-of-network provider, your out-of-pocket costs will be significantly higher, particularly for Prime members who would be hit with "Point-of-Service" fees.

### When a Referral is Required Referrals and/or prior authorizations are mandatory in the following scenarios: * **Active Duty Service Members:** You must always start with your PCM or military hospital/clinic. Seeking civilian mental health care without a referral can lead to denied claims and disciplinary action. * **Psychoanalysis:** This specific treatment requires prior authorization for all beneficiaries. * **Institutional Care:** If you require intensive outpatient programs (IOP), partial hospitalization programs (PHP), or residential treatment center (RTC) care, your provider must submit an authorization request to your regional contractor (**Humana Military** in the East or **TriWest** in the West).

### Costs and Copays (2026 Rates) Costs depend on your beneficiary "Group" (Group A joined before 2018; Group B joined in 2018 or later). * **Active Duty:** $0 for all authorized care. * **TRICARE Prime (Retirees/Families):** Generally $0 at military clinics. For 2026, network outpatient mental health copays for retirees are approximately $38–$40 per visit (varies by group — check TRICARE.mil for exact 2026 rate schedules). * **TRICARE Select:** Group A retirees typically pay roughly $30–$35 per visit in 2026, while Group B beneficiaries pay a percentage or a set fee based on current annual rate updates.

### Finding a Provider To ensure you aren't billed at out-of-network rates, use the provider directories provided by the regional contractors: * **East Region:** Humana Military. * **West Region:** TriWest Healthcare Alliance.

## Who this affects * **Active Duty Service Members:** Highest level of restriction; referral always required for civilian care. * **Active Duty Family Members (ADFMs):** No referral needed for network outpatient therapy. * **Retirees and their Families:** No referral needed for network outpatient therapy. * **National Guard/Reserve:** (on TRS) No referral needed for network outpatient therapy.

## Sources * TRICARE.mil Mental Health Care Services: https://www.tricare.mil/MentalHealth * Humana Military (East): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West): https://www.triwest.com/ * Defense Health Agency (DHA): https://health.mil/