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

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## Quick answer TRICARE allows beneficiaries to get a second medical opinion for any covered medical condition or surgery. In most cases, you must obtain a referral from your Primary Care Manager (PCM) and prior authorization from your regional contractor (Humana Military in the East or TriWest in the West) to ensure the cost is covered.

Details

Seeking a second opinion is a common practice when facing a major surgery, a life-altering diagnosis, or when initial treatments are not working. TRICARE’s rules for second opinions depend largely on your specific plan and whether you are staying within the TRICARE network.

### TRICARE Prime and Prime Remote Members enrolled in TRICARE Prime plans are required to have a referral from their Primary Care Manager (PCM) for most specialty care. * **The Referral Process:** You should discuss the request with your PCM first. They will submit a referral to your regional contractor (Humana Military or TriWest Healthcare Alliance). * **Authorization:** Even if your PCM agrees, the regional contractor must authorize the second opinion to ensure the consultant is a TRICARE-authorized provider. * **Point-of-Service (POS) Option:** If you see a doctor for a second opinion without an authorized referral, you will likely be charged under the Point-of-Service option. This involves a much higher deductible and a 50% cost-share for the visit.

### TRICARE Select and Reserve Select Beneficiaries using TRICARE Select, TRICARE Reserve Select (TRS), or TRICARE Retired Reserve (TRR) generally have more flexibility. * **No Referral Required:** You typically do not need a referral for a second opinion from a network provider. * **Costs:** You will pay according to your plan's 2026 cost-share and deductible schedule for a standard office visit. Using a non-network provider will result in significantly higher out-of-pocket costs.

### Surgical Second Opinions If a doctor recommends elective surgery, TRICARE specifically covers a second opinion. If the second opinion conflicts with the first, TRICARE will even cover a third opinion. * **2026 Costs:** For Active Duty Service Members (ADSMs), these visits are $0. For others, costs follow the standard specialist copay (e.g., for "Group A" retirees in 2026, a network specialist visit is typically around $37–$50, depending on specific plan updates).

### Second Opinions for Mental Health The rules for mental health vary. While some outpatient mental health visits do not require a referral for TRICARE Select users, Prime users may still need authorization for specific diagnostic testing or intensive outpatient programs related to a second opinion.

## Who this affects * **Active Duty Service Members (ADSMs):** Requires PCM referral and military command coordination in some cases. * **Active Duty Family Members (ADFMs):** Covered under Prime or Select rules. * **Retirees and their Families:** Covered; subject to 2026 enrollment fees and cost-shares. * **National Guard and Reserve:** Covered via TRICARE Reserve Select or TAMP. * **Survivors and Medically Retired:** Eligible under standard Prime or Select guidelines.

## Sources * **TRICARE.mil:** [Referrals and Pre-Authorizations](https://www.tricare.mil/referrals) * **TriWest (West Region):** [Provider Network Information](https://www.triwest.com) * **Humana Military (East Region):** [Seeking Second Opinions](https://www.humanamilitary.com) * **TRICARE.mil:** [Cost Terms Explained](https://www.tricare.mil/costs)