Understanding TRICARE®: A Quick Guide to HealthCare Plans
You care for service members, retirees, and their families every day. To support them well, you need to understand the TRICARE health plans they use. When you understand how these plans work, you can provide timely care, file accurate claims, and avoid billing issues.
Confirm TRICARE Coverage Up Front
Confirm TRICARE Coverage Up Front
Confirm your beneficiary’s TRICARE plan before determining coverage or starting treatment. A Uniformed Services ID card does not show plan type, so verify eligibility through the provider portal, Availity. This ensures you know whether the patient is enrolled in TRICARE Prime, TRICARE Select, or a specialty plan, and what referral, authorization, or cost‑sharing requirements apply.
How to Verify Coverage
- Log in to the provider portal, Availity.
- From the top navigation menu, select Patient Registration.
- Open the Eligibility and Benefits Inquiry application.
- Select the TRIWEST - TRICARE payer.
- Enter the required patient information.
- For TRICARE inquiries, the Member ID must be one of the following without dashes or spaces:
- the patient’s nine-digit Social Security Number (SSN)
- the patient’s 11-digit DEERS Beneficiary Number (DBN)
- Submit the inquiry to view the patient’s eligibility and benefit details.
TRICARE Prime
TRICARE Prime is a managed care option. Beneficiaries have a primary care manager who delivers routine care, coordinates treatment, and provides specialty referrals.
TRICARE Prime plans include:
- TRICARE Prime: Beneficiaries are assigned to a PCM who gives routine care, coordinates treatment, and provides referrals for specialty care. Submit referrals to TriWest Healthcare Alliance (TriWest) through the provider portal, Availity. This approach helps your patients get the authorizations they need before they receive care.
- TRICARE Prime Remote: TPR is a managed care plan for active duty service members and family members who live and work more than 50 miles away from a military hospital or clinic.
- TRICARE Prime Overseas: This managed care option is available in overseas locations near military hospitals and clinics. It supports active duty service members and command-sponsored family members stationed abroad.
- TRICARE Prime Remote Overseas: This option supports active duty service members and command-sponsored family members who live in designated remote overseas locations in Eurasia-Africa, Latin America, Canada, and the Pacific.
- US Family Health Plan: This TRICARE Prime option works with local, non-profit health systems in six regions. Even though it is part of TRICARE, people enrolled in USFHP get all their care, including pharmacy services, from a primary care provider they choose from a network of private doctors. The PCP helps schedule specialist visits in the area and guides the patient’s overall care.
TRICARE Select
TRICARE Select is a preferred provider option. It gives patients more choices. Beneficiaries may see any TRICARE‑authorized provider without a referral, though some services still need pre‑authorization.
TRICARE Select plans include:
- TRICARE Select: TRICARE Select is a self-managed PPO plan available in the United States. Beneficiaries may see any TRICARE‑authorized provider without a referral, though some services still need approval.
- TRICARE Select Overseas: This plan covers eligible beneficiaries in any overseas area. Patients must show as TRICARE-eligible in DEERS and must enroll to use this plan.
Specialty TRICARE Plans
Specialty TRICARE plans support Medicare‑eligible beneficiaries, Reserve members, and adult children.
Specialty TRICARE plans include:
- TRICARE For Life: TFL is Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and Part B. It works worldwide. TFL coverage applies only to the beneficiary who has Medicare and TRICARE eligibility and does not extend to family members.
- TRICARE Reserve Select: TRS is a premium-based health plan available worldwide for qualified Selected Reserve members and eligible family members. It works similarly to TRICARE Select, with monthly premiums and specific eligibility requirements.
- TRICARE Retired Reserve: TRR is a premium-based health plan for qualified retired Reserve members under age 60 and their eligible family members. It provides coverage until retired Reserve members reach age 60 and qualify for other TRICARE plans.
- TRICARE Young Adult: TYA is a premium-based plan for eligible adult children who lose regular TRICARE coverage at age 21 (or 23 if enrolled in college). TYA offers two options, TYA Prime and TYA Select, with medical and pharmacy benefits.
- Plan Finder: Plan Finder: This tool lets beneficiaries compare TRICARE plans side by side.
- Compare Plans: This tool lets beneficiaries compare two or more TRICARE health plans side by side. It can help you explain differences in coverage, referrals, and costs so patients understand their options.
For more information on TRICARE health plans, visit: https://www.tricare.mil/Plans/HealthPlans.