TRICARE Network vs. Non-Network Providers Compared | TRICARE.com

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## Quick answer The difference between TRICARE network and non-network providers is what you pay out of pocket and who files the paperwork. Network providers have a contract with Humana Military (East) or TriWest (West) to charge lower negotiated rates and file claims for you, while non-network providers can charge up to 15% more than the TRICARE-allowable amount and may require you to pay upfront.

Details

Choosing between network and non-network care determines your financial liability and administrative burden. Under the current T-5 contract, TRICARE divides its civilian providers into two specific categories.

### 1. Network Providers Network providers have signed a contract with the regional contractor (Humana Military in the East Region; TriWest Healthcare Alliance in the West Region).

* **Costs:** You only pay your set copayment (for TRICARE Prime) or your cost-share percentage (for TRICARE Select). For example, a Group A retiree on TRICARE Select in 2026 typically pays a fixed network copay for primary care rather than a percentage. * **Billing:** The provider is required by contract to file claims with TRICARE on your behalf. * **Referrals:** If you are in TRICARE Prime, your Primary Care Manager (PCM) is almost always a network provider or a military clinic provider.

### 2. Non-Network Providers Non-network providers do not have an agreement with TRICARE contractors. These are further split into two types:

* **Participating Providers:** They do not have a permanent contract but agree to accept the "TRICARE-allowable charge" as full payment on a case-by-case basis. They usually file the claim for you. * **Non-Participating Providers:** They do not agree to TRICARE's rates. They can legally charge you up to 15% above the TRICARE-allowable amount. This is known as "balance billing." You will likely have to pay the full bill upfront and file a claim yourself to be reimbursed by TRICARE for the portion they cover.

### Cost Comparison Example (2026 Estimated) If a specialist visit has a TRICARE-allowable rate of $100: * **Network (Select Group A):** You pay a fixed copay (e.g., $39 in 2026). * **Non-Network (Participating):** You pay a 20% cost-share ($20). * **Non-Network (Non-Participating):** You pay 20% cost-share ($20) PLUS the 15% balance billing ($15), totaling $35 out-of-pocket, and you must file the paperwork.

### Important Restrictions * **Active Duty:** Active Duty Service Members (ADSMs) must generally use military hospitals or network providers with a referral. Seeking non-network care without an authorization can result in the member being responsible for the entire bill. * **Point-of-Service (POS) Option:** If you are enrolled in a Prime plan and see a non-network provider without a referral (for non-emergency care), you will be charged under the Point-of-Service option. This includes a high deductible ($300 for individuals) and a 50% cost-share.

## Who this affects * **TRICARE Select Enrollees:** Generally have the most flexibility to choose between network and non-network providers. * **TRICARE Prime Enrollees:** Affected if they choose to go "out-of-network" via the Point-of-Service option. * **TRICARE For Life (TFL) Beneficiaries:** Affected when seeking care not covered by Medicare but covered by TRICARE. * **Active Duty Family Members (ADFMs):** Impacted by higher cost-shares when moving outside the network. * **Retirees and their Families:** Impacted by higher cost-shares and potential 15% balance billing.

## Sources * **TRICARE.mil:** [Find a Doctor](https://www.tricare.mil/findaprovider) * **Humana Military (East):** [Provider Directory](https://www.humanamilitary.com/beneficiary/find-care) * **TriWest Healthcare Alliance (West):** [Provider Search](https://www.triwest.com/en/beneficiary/) * **TRICARE.mil:** [Cost Terms Explained](https://tricare.mil/Costs/Cost-Terms)