What is an ADSM? | TRICARE Glossary Definition | TRICARE.com

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## Definition ADSM stands for **Active Duty Service Member**, referring to any person currently serving full-time in the U.S. Army, Navy, Air Force, Marine Corps, Coast Guard, Space Force, or the Commissioned Corps of the NOAA or Public Health Service.

## What it means in practice For a TRICARE beneficiary, being an ADSM means your healthcare is managed differently than any other category of user. ADSMs are legally required to enroll in **TRICARE Prime** (or TRICARE Prime Remote if in a remote location). Unlike retirees or family members, ADSMs do not have the option to choose TRICARE Select. Under the T-5 contract (effective 2025/2026), ADSMs in the East Region are managed by Humana Military, while those in the West Region are managed by TriWest Healthcare Alliance.

The most significant financial benefit for an ADSM is that they have **$0 out-of-pocket costs** for all covered medical services. For the 2026 plan year, ADSMs pay $0 for enrollment, $0 deductibles, and $0 copayments for care received at Military Medical Treatment Facilities (MTFs) or through civilian providers with a proper referral. ADSMs also receive priority access to care at MTFs over all other beneficiary groups.

Civilian care for an ADSM is strictly regulated. Except for true emergencies, an ADSM must obtain a referral from their Primary Care Manager (PCM) and, in many cases, a "fitness-for-duty" review to ensure the treatment does not impact their deployability. If an ADSM seeks non-emergency civilian care without a referral, the "Point-of-Service" option does not apply as it does for family members; instead, the service member may be held responsible for the entire bill and may face military disciplinary action.

Pharmacy benefits for ADSMs are also comprehensive. While they are encouraged to use MTF pharmacies for $0 costs, they can also use the Express Scripts mail-order pharmacy or retail network pharmacies. For the 2026 plan year, ADSMs continue to have $0 copays for medications at all three venues, provided the prescription is filled within the TRICARE network.

## Related terms * **ADFM (Active Duty Family Member):** Spouses and children of ADSMs who have different plan options (Prime or Select) and potential cost-shares. * **PCM (Primary Care Manager):** The designated provider (military or civilian) who coordinates all care and referrals for an ADSM. * **MTF (Military Medical Treatment Facility):** A clinic or hospital located on a military base where ADSMs receive priority care. * **T-5 Contract:** The fifth generation of TRICARE managed care contracts, currently governing the East and West regions under Humana Military and TriWest. * **Fitness-for-Duty:** An evaluation used to determine if an ADSM’s medical condition interferes with their ability to perform military duties.

## Sources * TRICARE.mil: Eligibility for Active Duty Service Members - https://www.tricare.mil/Plans/Eligibility/ADSM * Defense Health Agency (DHA) Common Definitions - https://health.mil/ * TriWest Healthcare Alliance (West Region Contractor) - https://www.triwest.com/ * Humana Military (East Region Contractor) - https://www.humanamilitary.com/