Find a Provider, Get the Care You Need with TRICARE
Have you seen your doctor in the last year? If not, it’s time to make an appointment. Seeing your doctor for regular checkups is one of the best ways to screen for diseases and prevent future health problems. And it’s something you can do safely during the COVID-19 pandemic. If you’re looking for a doctor, TRICARE can help. Your coverage enables you to visit several types of providers. You may get care from a provider at a military hospital or clinic or from a civilian TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS.
Here are some things you and your family should consider when looking for a provider near you.
Are you seeking care outside of a military hospital or clinic? Depending on your health plan and the type of care you need, you may have the option of visiting either a network or non-network provider. Both are TRICARE-authorized providers, but choosing a network provider may minimize your out-of-pocket costs. As outlined in the TRICARE Choices in the United States Handbook, network providers have agreed to accept the contracted rate as payment in full for covered health care services and file claims for you.
Network providers overseas also have an agreement with the TRICARE overseas contractor. They agree to provide cashless and claimless services to those in TRICARE Overseas Program (TOP) Prime and TOP Prime Remote. But these providers don’t have to file claims for those in TOP Select. You can learn more about overseas providers in the TRICARE Overseas Program Handbook.
Two kinds of non-network providers
Non-network providers, on the other hand, haven’t signed an agreement with your TRICARE contractor. There are two types of non-network providers—participating and nonparticipating. Among non-network providers, using a participating provider is your less expensive option. These providers may file claims for you and accept TRICARE payment as the full payment for covered health care services. Outside the U.S. and U.S. territories, you may receive cashless and claimless services if you have TOP Prime or TOP Prime Remote.
Nonparticipating providers don’t accept TRICARE payment as the full payment for covered services. You should expect to pay the provider first and file a claim with TRICARE to get money back. If stateside, these providers may charge you up to 15% above the TRICARE-allowable chargeThe maximum amount TRICARE pays for each procedure or service. This is tied by law to Medicare's allowable charges. for services. You’re responsible for paying this amount as well as applicable patient costs. If you’re overseas, there may be no limit to the amount that a nonparticipating non-network provider may bill you. You’re responsible for paying any amount that exceeds the TRICARE-allowable charge.
Finding a TRICARE-authorized provider is simple
Ready to find a provider? Just use the Find a Doctor tool to locate a provider in your area. You can also search your TRICARE contractor’s online provider directory:
Using TRICARE For Life?
Your provider options also differ if you have TRICARE For Life.
“If you’re enrolled in Original Medicare, you may visit Medicare participating, Medicare non-participating, or opt-out providers,” said Anne Breslin, the TRICARE For Life program manager at the Defense Health Agency. “If you’re enrolled in a Medicare Advantage plan, follow your plan’s rules for getting care. Remember that in the U.S. and U.S. territories, TRICARE pays after Medicare and other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance." for TRICARE covered services.”
To find a Medicare provider:
- Search the Medicare Provider Directory
- Call 1-800-MEDICARE (1-800-633-4227)
As you search for a provider who meets your needs, remember that some services may require a referral or pre-authorization depending on your plan’s rules. To learn more about your coverage, choose your health plan. Take command of your health, and contact your TRICARE contractor if you have questions.
Last Updated 2/18/2021