How to Enroll in TRICARE: A Step-by-Step Guide for Service Members and Families

Last updated 4 days ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.

This guide will help you understand and enroll in TRICARE, the health care program for the U.S. military community. We’ve broken down the process into clear, actionable steps for service members and their families.

What is TRICARE?

TRICARE is the official health care program designed for Uniformed Service members, retirees, and their families worldwide. It falls under the management of the Defense Health Agency (DHA) and operates as a component of the Military Health System (MHS).

The mission of TRICARE is to enhance national security by providing health support for military operations and to protect the health of all beneficiaries entrusted to its care.

How TRICARE Works

TRICARE functions through a hybrid system that combines:

• Military Treatment Facilities (MTFs): Military hospitals and clinics, also called “Direct Care”
• Civilian Healthcare Network: Civilian providers, institutions, pharmacies, and suppliers, known as “Private Sector Care”

Where you receive care—whether through an MTF or civilian provider—depends on your TRICARE plan, location, and the capacity of nearby military facilities.

Who is Covered

TRICARE extends coverage to a wide range of individuals connected to the uniformed services:

• Active Duty Service Members (ADSMs) and their families
• National Guard and Reserve members and their families
• Military retirees and their families
• Survivors of deceased service members
• Certain former spouses
• Medal of Honor recipients and their families
• Other groups registered in the Defense Enrollment Eligibility Reporting System (DEERS)

TRICARE itself doesn’t determine eligibility; this decision comes from the sponsor’s specific uniformed service, which reports eligibility status in DEERS.

Comprehensive Coverage

TRICARE provides comprehensive health coverage with plans tailored to different beneficiary groups. Beyond standard medical care, TRICARE includes special programs for:

• Cancer clinical trials
• Durable medical equipment
• Home health care
• Hospice
• Mental health and substance use disorder treatment
• Applied behavior analysis for autism spectrum disorder

Prescription drug coverage is included, and separate options exist for dental and vision coverage.

For the most current information about TRICARE benefits, plans, and procedures, visit the official TRICARE website.

Are You Eligible? Understanding TRICARE and DEERS

Eligibility Categories

Eligibility for specific TRICARE plans is tied to the beneficiary’s category, determined by their relationship to the military sponsor and the sponsor’s status. Key eligibility groups include:

• Active Duty Service Members (ADSMs) and their families: Spouses and children of those currently serving on active duty
• National Guard/Reserve members and their families: Eligibility varies based on the member’s duty status (drilling, activated, recently deactivated)
• Retired Service Members and their families: Those who completed qualifying service and receive retirement pay
• Retired Reserve members and their families: Members of the Reserve Component qualified for retirement but under age 60 (“gray-area retirees”)
• Survivors: Eligible family members of deceased sponsors
• Certain Former Spouses: Individuals previously married to a service member who meet specific criteria (20/20/20 or 20/20/15 rules)
• Medal of Honor recipients and their families
• Dependent Parents and Parents-in-law: Eligibility must be determined by the sponsor’s branch of service
• Others Registered in DEERS: May include foreign force members and their families stationed in the U.S. under specific agreements

DEERS: The Foundation of Eligibility

The Defense Enrollment Eligibility Reporting System (DEERS) is the central DoD database containing personnel and benefits information. Registration in DEERS is the essential key that unlocks TRICARE eligibility and allows for enrollment.

Maintaining accurate DEERS information is critical. Errors like incorrect addresses, outdated marital status, or missing family members can directly impede access to care, leading to problems with:

• Verifying eligibility at appointments
• Processing claims correctly
• Obtaining necessary referrals or authorizations
• Ensuring timely delivery of prescriptions through mail order

DEERS Registration Process

The process for getting registered in DEERS varies slightly:

• Sponsors: Active duty, retired, and National Guard/Reserve members are generally registered automatically in DEERS as part of their service processing.
• Family Members: Sponsors must register their eligible family members (spouses, children). This typically requires visiting a local ID card office, also known as a RAPIDS facility, in person. Bring original or certified copies of required documentation, such as marriage certificates, birth certificates, or adoption papers. Locate the nearest ID card office using the online locator tool and call ahead to verify hours and appointment requirements.
• Special Cases: If both parents are service members, they must decide which parent will be listed as the sponsor for each child in DEERS. For dual-military couples, each should still be registered as a dependent spouse under their partner’s record to ensure all potential DoD benefits are correctly reflected.

Keeping DEERS Updated – A Continuous Responsibility

Keeping DEERS information current is an ongoing responsibility. Update DEERS promptly whenever a Qualifying Life Event (QLE) occurs, such as:

• Changes in the sponsor’s military status (activating for Guard/Reserve, retiring, separating from service)
• Changes in family status (marriage, divorce, birth of a child, adoption)
• Moving to a new residence
• Becoming eligible for Medicare
• Death of the sponsor or a registered family member

Sponsors handle major updates like adding dependents or changing marital status. Prompt communication within the family is essential, as delays in updating DEERS could lead to issues when seeking care.

How to Update DEERS

The method for updating DEERS depends on the type of information being changed:

Contact Information (Address, Email, Phone)

Sponsors and registered family members (age 18 and older) can update their own contact information through several methods:

• Online: Log into the milConnect portal. Navigate to update contact information or use the ID Card Office Online feature.
• Phone: Call the DMDC/DEERS Support Office (DSO) at 1-800-538-9552 (TTY/TDD: 1-866-363-2883).
• Fax/Mail: Send updated information via fax or mail to the addresses provided by the DSO.

Eligibility-Affecting Information

Changes like adding/removing family members, name changes, date of birth corrections, or SSN updates typically require documentation and an in-person visit by the sponsor to an ID card office. Always call ahead to confirm required documentation.

DEERS Resources

• DEERS Information Page (TRICARE)
• milConnect Portal (Check/Update Info)
• DMDC/DEERS Support Office (DSO) Phone: 1-800-538-9552 (TTY/TDD: 1-866-363-2883)
• ID Card Office Locator

Choosing Your TRICARE Plan: Key Options

Plan Availability

TRICARE offers various health plans, but not every plan is available to every beneficiary. Options depend primarily on the sponsor’s military status and the beneficiary’s geographic location. Use TRICARE’s online tools to determine which plans you qualify for.

TRICARE Prime Plans (Managed Care / HMO-like)

TRICARE Prime plans operate similarly to civilian Health Maintenance Organizations (HMOs) and represent the managed care option within the TRICARE system.

Features

Enrollment in a Prime plan means being assigned a specific Primary Care Manager (PCM), who could be located at an MTF or be a civilian network provider. Your PCM serves as the main point of contact for most healthcare needs, manages routine care, provides referrals for specialist visits, and coordinates with the regional contractor for required authorizations.

Care is often delivered through MTFs when available, supplemented by civilian network providers. When following the plan’s rules (using the PCM, getting referrals), Prime plans generally feature the lowest out-of-pocket costs. Enrollment is mandatory to participate.

Who Enrolls

Prime enrollment is mandatory for all Active Duty Service Members (ADSMs). For Active Duty Family Members (ADFMs) and other eligible beneficiaries (like retirees not yet eligible for Medicare), enrollment in Prime is optional but only available if they reside within designated Prime Service Areas (PSAs) in the United States.

Retirees generally lose eligibility to enroll in TRICARE Prime once they become eligible for Medicare based on age.

Variants

• TRICARE Prime Remote (TPR): Designed for ADSMs and their enrolled family members who live and work in designated remote locations within the U.S., typically more than 50 miles or a one-hour drive from the nearest MTF.
• TRICARE Prime Overseas (TOP Prime): The Prime option available to ADSMs and their command-sponsored family members residing in non-remote overseas locations.
• TRICARE Prime Remote Overseas (TOP Prime Remote): The Prime option for ADSMs and their command-sponsored family members stationed in designated remote overseas areas.
• US Family Health Plan (USFHP): An additional TRICARE Prime option available only in six specific geographic regions across the U.S. Care is provided through established networks of community-based, not-for-profit healthcare systems, rather than directly through MTFs or standard TRICARE contractors. USFHP has its own provider network and separate pharmacy coverage arrangements. More information at USFHP website.

For detailed Prime information, visit TRICARE Prime page or www.tricare.mil/prime.

TRICARE Select Plans (PPO-like)

TRICARE Select plans function like civilian Preferred Provider Organizations (PPOs), offering more flexibility than Prime plans.

Features

The defining characteristic of TRICARE Select is the freedom it offers beneficiaries to manage their own healthcare. Beneficiaries can see any TRICARE-authorized provider they choose, without needing a referral from a PCM for most types of care, including specialist visits.

While this provides maximum flexibility, costs are lower when using providers within the TRICARE network compared to non-network providers. Select plans typically involve paying an annual deductible and then cost-shares or copayments for covered services.

When seeing non-network providers, beneficiaries might need to pay upfront for services and file their own claims for reimbursement.

Who Enrolls

TRICARE Select is broadly available worldwide to most beneficiaries who are not ADSMs and are not enrolled in a TRICARE Prime plan. This commonly includes ADFMs, retirees, and retiree family members.

While ADFMs do not pay enrollment fees for Select, retirees and certain other beneficiaries are required to enroll and may pay annual enrollment fees.

Variants

• TRICARE Select Overseas (TOP Select): This is the Select option available for eligible beneficiaries residing overseas who are not enrolled in TOP Prime.

For Select information, visit TRICARE Select page or www.tricare.mil/select.

Comparing Prime and Select

Selecting between TRICARE Prime and TRICARE Select involves evaluating personal priorities beyond just potential costs. The choice represents a fundamental difference in how you interact with the healthcare system.

Prime offers a structured, managed care approach with a designated PCM coordinating care and referrals, generally resulting in lower and more predictable out-of-pocket costs when plan rules are followed. This may be preferable for those who value cost certainty and don’t mind navigating the referral process.

Select offers greater autonomy and flexibility, allowing direct access to specialists and a wider choice of TRICARE-authorized providers without mandatory referrals. This freedom comes with potentially higher and less predictable costs due to deductibles and cost-shares, and requires beneficiaries to take a more active role in managing their care and potentially claims filing.

Factors like family health needs, budget tolerance for variable costs, desire for provider choice, and proximity to MTFs versus civilian network providers all play a role in determining the most suitable plan.

TRICARE Reserve Select (TRS)

Features

TRS is a premium-based health plan specifically for qualified members of the Selected Reserve and their families. It provides coverage similar to TRICARE Select (PPO structure), allowing access to TRICARE-authorized providers worldwide. Participants pay monthly premiums to maintain coverage.

Eligibility

To qualify for TRS, an individual must be a member of the Selected Reserve (units associated with the Air Force Reserve, Air National Guard, Army Reserve, Army National Guard, Navy Reserve, Marine Corps Reserve, or Coast Guard Reserve).

Members of the Individual Ready Reserve (IRR), including Navy Reserve Voluntary Training Units (VTUs), are generally not eligible. Additionally, the qualifying Reserve member must not be on federal active duty orders for more than 30 consecutive days, must not be covered under the Transitional Assistance Management Program (TAMP), and (under current law effective until January 1, 2030) must not be eligible for or enrolled in the Federal Employees Health Benefits (FEHB) program based on their civilian employment.

A sponsor must first qualify for and purchase TRS coverage before their eligible family members can enroll.

For TRS information, visit TRICARE Reserve Select page.

TRICARE Retired Reserve (TRR)

Features

TRR is another premium-based plan, structured like TRICARE Select, designed for retired members of the Reserve Component who are not yet age 60 (often called “gray-area retirees”) and their families. It offers comprehensive coverage worldwide. Enrollment requires payment of monthly premiums.

Eligibility

Eligibility is limited to Retired Reserve members who are qualified for non-regular retirement (i.e., have received their “20-year letter”) but are under age 60. They must also not be eligible for or enrolled in the FEHB program.

Eligible family members of qualified Retired Reserve members can also enroll, as can certain survivors under specific conditions. TRR coverage ceases when the Retired Reserve member turns 60, at which point they become eligible for the same TRICARE plans as other military retirees.

For TRR information, visit TRICARE Retired Reserve page.

TRICARE Young Adult (TYA)

Features

TYA is a premium-based option that allows qualified young adults to purchase TRICARE coverage after they lose eligibility for regular TRICARE plans due to age (typically at age 21, or 23 if a full-time college student).

TYA is an individual plan (not a family plan) and offers options mirroring both Prime (TYA-Prime) and Select (TYA-Select) structures, providing comprehensive medical and pharmacy benefits. Dental coverage is excluded. Monthly premium payments are required.

Eligibility

To purchase TYA, an individual must be:

• An unmarried, adult child of an eligible TRICARE sponsor (whose sponsor has qualifying coverage, e.g., ADSM, Retiree, TRS/TRR member)
• At least age 21 but not yet 26 years old (eligibility might start at age 23 for full-time students meeting support requirements)
• Not eligible to enroll in an employer-sponsored health plan based on their own employment
• Not otherwise eligible for any other TRICARE coverage

An ID card is not strictly required to enroll, but obtaining one is recommended. Availability of the TYA-Prime option depends on the young adult’s location (e.g., must be in a PSA) and the sponsor’s status (e.g., TYA-Prime is not available if the sponsor is enrolled in TRS or TRR).

For TYA information, visit TRICARE Young Adult page.

TRICARE For Life (TFL)

Features

TFL is not a plan one enrolls in, but rather automatic coverage that acts as a secondary payer to Medicare. For beneficiaries in the U.S. and U.S. territories, Medicare pays first for Medicare-covered services, and TFL pays most of the remaining costs.

There are no TFL enrollment forms to fill out and no separate TFL enrollment fees. However, beneficiaries must be enrolled in Medicare Part B and pay the associated monthly premiums to maintain TFL coverage.

Eligibility

TFL coverage applies to TRICARE beneficiaries who are entitled to Medicare Part A and are enrolled in Medicare Part B. This primarily includes military retirees and their eligible family members and survivors who reach age 65. It also applies to beneficiaries under age 65 who become entitled to Medicare due to a disability or end-stage renal disease, provided they are enrolled in Part B.

For TFL information, visit TRICARE For Life page.

Plan Comparison Tools

To aid in navigating these options, TRICARE provides helpful online tools:

• Plan Finder Tool: Asks questions about status and location to narrow down eligible plan choices
• Compare Plans Tool: Allows side-by-side comparison of features for up to six selected plans

TRICARE Plan Comparison Overview

Step-by-Step: How to Enroll in TRICARE

Enrolling in a TRICARE plan involves several key steps. Remember that except for ADSMs automatically placed in Prime, enrollment requires deliberate action by the sponsor or beneficiary.

Step 1: Confirm Eligibility in DEERS

The absolute first step is to ensure that the beneficiary (and all family members needing coverage) are correctly registered in DEERS. An accurate DEERS record is the prerequisite for any TRICARE enrollment.

Eligibility can be verified by logging into the milConnect portal and checking the “Benefits” section, specifically under “Beneficiary Web Enrollment (BWE)”. Alternatively, confirmation can be obtained by calling the DMDC/DEERS Support Office (DSO) at 1-800-538-9552.

Any discrepancies or missing information in DEERS must be resolved before attempting to enroll in a TRICARE plan.

Step 2: Choose the Right Plan

Once DEERS eligibility is confirmed, the next step is selecting the most appropriate TRICARE plan. This decision should be based on confirmed eligibility (from Step 1), geographic location, anticipated healthcare needs, provider preferences, and budget considerations.

Utilize the official TRICARE resources to compare options:

• Plan Finder: Helps identify eligible plans based on user profile
• Compare Plans Tool: Provides a side-by-side comparison of plan features
• Compare Costs Tool: Details potential out-of-pocket expenses for different plans
• Plan-Specific Webpages: Review detailed information on each plan

Step 3: Enroll (If Required)

Enrollment is an active process for most TRICARE plans, including TRICARE Prime (except ADSMs), TRICARE Select (for those required to pay fees, like retirees), TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR), and TRICARE Young Adult (TYA).

While ADSMs are automatically enrolled in Prime, they may still need to complete and submit an enrollment form to select a PCM.

Enrollment Methods

Several methods are available for enrollment, depending on the plan and beneficiary location:

Online (Often the most convenient method)

The Beneficiary Web Enrollment (BWE) portal, accessed via milConnect, is the primary online tool for enrollment. Logging in requires a Common Access Card (CAC), a DFAS (myPay) account login, or a DoD Self-Service (DS) Logon.

Once logged in, users can select “Manage health benefits” or navigate to the BWE section to enroll in Prime or Select, or to initiate the purchase process for TRS, TRR, or TYA.

For premium-based plans like TRS and TRR, the BWE system helps generate the required enrollment form (DD Form 2896-1).

Note for TRS/TRR applicants using BWE: Be careful not to incorrectly indicate FEHB eligibility if not applicable, as this can prevent qualification.

By Phone

Enrollment or purchase can often be initiated by calling the appropriate TRICARE Regional Contractor:

• East Region (Humana Military): 1-800-444-5445
• West Region (TriWest Healthcare Alliance): 1-888-TRIWEST (874-9378)
• Overseas (International SOS): Check TRICARE Overseas contact page for country-specific numbers, or use the general stateside number 1-800-523-8662 if applicable

By Mail/Fax

Enrollment forms can be downloaded from the TRICARE website (e.g., TRICARE Prime Enrollment, Change, and Disenrollment Form; TRICARE Young Adult Application DD Form 2947) or generated via BWE (e.g., Reserve Component Health Coverage Request Form DD 2896-1).

Completed forms must be signed and submitted to the correct regional contractor (addresses are typically on the forms or contractor websites). For premium-based plans (TRS, TRR, TYA), the initial premium payment must usually accompany the mailed/faxed application.

In Person (Overseas)

For beneficiaries located overseas, enrollment or purchase requests for certain plans (like TRS, TRR, TYA) may sometimes be submitted at a TRICARE Service Center.

Necessary Information

When enrolling, be prepared to provide essential details such as the sponsor’s Social Security Number (SSN) or DoD Benefits Number (DBN), full names and dates of birth for all enrolling beneficiaries, the chosen TRICARE plan, contact information, and potentially payment details (bank account for EFT or credit/debit card) for the initial premium if enrolling in a premium-based plan.

When to Enroll: Timing, Open Season, and Life Changes

Timing is crucial when enrolling in or changing TRICARE plans. Missing deadlines can lead to gaps in coverage or limit options until the next enrollment opportunity.

Initial Enrollment

• New ADSMs: Automatically enrolled in TRICARE Prime upon entering active duty.
• New Family Members (Spouse, Child): Must first be registered in DEERS by the sponsor. Once registered, they need to be actively enrolled in a plan (if choosing Prime, an enrollment form is required).
• Newborns and Adopted Children: Have special initial coverage periods. In the U.S., they are typically covered under TRICARE Prime for the first 60 days after birth or adoption (if another family member is enrolled in Prime). Overseas, this period is 120 days under TOP Prime. However, the sponsor must formally register the child in DEERS and enroll them in a TRICARE plan within this 60/120 day window. Failure to do so results in the child defaulting to TRICARE Select (or TOP Standard overseas) coverage, and for plans like TRS, the child has no coverage until actively enrolled.

TRICARE Open Season

TRICARE Open Season is an annual period, typically running from the Monday of the second full week in November to the Monday of the second full week in December.

During Open Season, beneficiaries currently enrolled in TRICARE Prime or TRICARE Select plans (who are eligible to make a choice) can change their health plan coverage for the following calendar year.

Beneficiaries enrolled in premium-based plans like TRS, TRR, TYA, or those covered by TFL, generally do not use Open Season to manage these specific coverages, as enrollment/purchase for these plans occurs year-round based on eligibility or automatically with Medicare enrollment for TFL.

Qualifying Life Events (QLEs)

QLEs are specific changes in life circumstances that permit beneficiaries to enroll in or change their TRICARE health plan outside of the annual Open Season. Acting promptly after a QLE is essential.

Common QLEs include:

• Military Status Changes: Sponsor activating (Guard/Reserve), deactivating, retiring, or separating from service
• Family Changes: Getting married, getting divorced, giving birth, adopting a child, death of the sponsor or a family member
• Moving: Changing residence, particularly if the move results in changing TRICARE regions or moving into or out of a Prime Service Area
• Changes in Other Health Insurance (OHI): Gaining or losing other health coverage (like employer-sponsored insurance)
• Medicare Eligibility: Becoming eligible for Medicare (usually at age 65 or due to disability)
• Aging Out: Dependent children reaching age 21 (or 23 if a full-time student), losing regular TRICARE eligibility but potentially gaining eligibility for TYA
• Government-Directed Changes: Such as the government discontinuing a plan

QLE Enrollment Window

The ability to make enrollment changes following a QLE is time-limited. Beneficiaries generally have 90 days from the date of the qualifying event to make eligible changes to their TRICARE enrollment.

For events like birth or adoption, the window to enroll the new child is 90 days stateside or 120 days overseas. This 90-day window is critical; failure to act within this timeframe typically means the opportunity to change coverage is lost until the next TRICARE Open Season, unless another QLE occurs.

Coverage Start Dates

• Open Season Changes: Changes made during Open Season generally take effect on January 1st of the following year.
• QLE Changes: Enrollment changes made due to a QLE are often effective retroactively to the date of the event itself, provided the enrollment action is completed within the 90-day window. Specific rules may vary by QLE, so confirmation is advised.
• TRS/TRR Purchase: For initial purchase outside of a QLE transition, coverage typically begins on the first day of the month following receipt of the enrollment form and payment, or the first of the subsequent month, depending on the request and submission date.
• TYA Purchase: TYA coverage generally starts on the date the completed application and initial payment are received by the contractor, or on a future date specified by the applicant (up to 90 days in the future).

Resources

• Life Events Information
• Qualifying Life Events Page/Fact Sheet (Search for “Qualifying Life Events”)
• Open Season Information: Updated seasonally on the main TRICARE website

Understanding TRICARE Costs: Fees, Premiums, and Copays

Out-of-pocket costs associated with TRICARE can vary considerably based on several factors. Understanding these cost components is essential for budgeting and making informed plan choices.

Key Factors Influencing Costs

• TRICARE Plan: Each plan (Prime, Select, TRS, TRR, TYA, TFL) has a distinct cost structure.
• Sponsor’s Status: Costs differ significantly for active duty versus retired sponsors. For retirees and their families, costs are further tiered based on when the sponsor initially entered the uniformed services (Group A: before January 1, 2018; Group B: on or after January 1, 2018).
• Beneficiary Category: Costs can vary between sponsors, spouses, children, survivors, etc.
• Provider Type/Location: Where care is received (e.g., MTF, civilian network provider, civilian non-network provider) impacts costs, particularly for Select-type plans.

Types of Costs

Enrollment Fees/Premiums

These are recurring payments required to maintain coverage under certain plans.

• TRICARE Prime: Generally, no enrollment fees for ADSMs, ADFMs, and transitional survivors. Retirees (pre-Medicare) and their eligible family members typically pay annual enrollment fees. USFHP enrollment fees usually align with Prime fees.
• TRICARE Select: No annual enrollment fees for ADFMs. Retirees, their families, and others enrolled in Select typically pay annual enrollment fees, with different rates for Group A and Group B beneficiaries.
• TRS, TRR, TYA: These are premium-based plans requiring monthly premium payments. Premium rates are set annually and vary by plan and coverage type (member-only vs. family).
• TRICARE For Life (TFL): There are no separate enrollment fees or premiums for TFL coverage itself. However, maintaining TFL eligibility requires enrollment in Medicare Part B, which involves paying the standard monthly Part B premium directly to Medicare.

Deductibles

This is the amount a beneficiary must pay out-of-pocket for covered services each fiscal year (October 1 – September 30) before the TRICARE plan begins to pay its share.

Deductibles primarily apply to TRICARE Select, TRS, TRR, and TYA-Select plans. TRICARE Prime plans generally do not have an annual deductible for network care.

Cost-Shares and Copayments

These represent the beneficiary’s portion of the cost for covered healthcare services after the deductible (if applicable) has been met.

• Copayment: A fixed dollar amount paid at the time of service (e.g., $30 for a specialist visit). TRICARE Prime typically uses copayments for services received from network providers. TRICARE Select may also use copayments for network care.
• Cost-Share: A percentage of the TRICARE-allowable charge for a service, usually paid after receiving care (e.g., 20% of the allowable charge for an outpatient procedure). TRICARE Select, TRS, TRR, and TYA-Select often use cost-shares, especially for care received from non-network providers.
• Point-of-Service (POS) Costs (Prime): If a Prime enrollee (other than an ADSM) seeks non-emergency care from a non-network provider without a referral from their PCM, the Point-of-Service option applies. This involves a deductible and higher cost-shares (typically 50% of the allowable charge).
• Balance Billing (Non-Network Providers): TRICARE-authorized non-network providers who do not accept TRICARE assignment (i.e., do not agree to accept the TRICARE-allowable charge as full payment) can bill the beneficiary up to 15% above the TRICARE-allowable amount. This additional charge, known as balance billing, is the beneficiary’s responsibility on top of their deductible and regular cost-share. Using network providers avoids this potential extra cost.

Catastrophic Cap (CC)

The Catastrophic Cap is a crucial safety net built into TRICARE. It represents the maximum amount a family pays out-of-pocket for TRICARE-covered services during a fiscal year (October 1 to September 30).

Once the family’s payments for enrollment fees (for Prime/Select), annual deductibles, copayments, and cost-shares reach the CC amount for their specific beneficiary category, TRICARE pays 100% of the TRICARE-allowable charges for all additional covered services for the remainder of that fiscal year.

Monthly premiums for TRS, TRR, and TYA do not count towards the CC. Importantly, costs incurred under the Prime Point-of-Service option also generally do not apply toward the Catastrophic Cap.

Payment Options

For plans requiring premiums or enrollment fees (TRS, TRR, TYA, retiree Prime/Select), TRICARE offers several payment methods. These often include:

• Payroll allotments (if the sponsor is eligible, e.g., retired military pay)
• Automatic electronic funds transfer (EFT) from a bank account
• Recurring payments via credit or debit card

Specific options should be confirmed with the regional contractor during enrollment. Timely payment is essential; failure to pay required premiums or fees can lead to disenrollment from the plan and may result in a lockout period (e.g., 12 months for TYA) during which the beneficiary cannot re-enroll.

Cost Resources

• Compare Costs Tool
• Costs and Fees Fact Sheet (PDF) (Accessible via TRICARE Publications)
• Plan-Specific Cost Pages: Available on the main TRICARE website

Getting Help: Key TRICARE Resources and Support

Successfully navigating TRICARE often involves knowing where to turn for specific types of assistance. The system has multiple components, each handling different functions.

Primary Websites

• Official TRICARE Site: Use for general program information, detailed plan descriptions, checking covered services, finding network providers, accessing publications, and staying updated on TRICARE news.
• milConnect Portal: Use for checking and updating DEERS contact information, verifying eligibility, enrolling in plans via Beneficiary Web Enrollment (BWE), viewing current health care coverage, obtaining proof of coverage letters (eCorrespondence), and managing other DoD benefits like SGLI or education benefits transfer.

Regional Contractors (for Enrollment, Claims, Network Management, Authorizations in the U.S.)

These contractors manage the delivery of the TRICARE benefit within their assigned geographic regions. Contact the contractor for the region where the beneficiary resides.

• TRICARE East Region: Managed by Humana Military.
  • Website: humanamilitary.com or tricare.mil/east
  • Phone: 1-800-444-5445
• TRICARE West Region: Managed by TriWest Healthcare Alliance (effective January 1, 2025).
  • Website: tricare-bene.triwest.com or tricare.mil/west
  • Phone: 1-888-TRIWEST (874-9378)
  • Note: For questions or claims related to care received in the West Region before January 1, 2025, contact the previous contractor, Health Net Federal Services (HNFS), through their legacy website until June 30, 2025.

Overseas Program Contractor

Managed by International SOS Government Services, Inc.

• Website: tricare-overseas.com
• Contact Page (for regional/country-specific numbers): tricare-overseas.com/contact-us
• General Phone (calling from the US): 1-800-523-8662 (may apply for specific inquiries, confirm via website)

TRICARE For Life Contractor (Claims Processing)

Managed by WPS Military and Veterans Health (WPS-TFL).

• Website: tricare4u.com
• Phone (U.S. & U.S. Territories): 1-866-773-0404

DEERS Support

For questions specifically about DEERS eligibility status or assistance with complex DEERS record updates that cannot be done online or at an ID card office.

• DMDC/DEERS Support Office (DSO):
  • Phone: 1-800-538-9552 (TTY/TDD: 1-866-363-2883)

Other Key Resources

• MHS Nurse Advice Line: Provides 24/7 access to registered nurses for urgent medical advice via phone, web chat, or video chat. Check tricare.mil for the current contact information.
• MHS GENESIS Patient Portal: The secure portal for accessing personal health information from military electronic health records, scheduling some appointments, and communicating securely with providers (replaced the old TRICARE Online portal). Access at: patientportal.mhsgenesis.health.mil.
• TRICARE Pharmacy Program Information: Details on pharmacy options (MTF, mail order, retail network, non-network) and the formulary (list of covered drugs): tricare.mil/pharmacy.
• TRICARE Dental Program Information: Details on separate dental plan options (enrollment and coverage are distinct from medical plans): tricare.mil/dental.

Beneficiaries should be aware that TRICARE systems and points of contact can evolve. The transition to the MHS GENESIS portal and changes in regional contractors are recent examples. Always verify current contact information, procedures, and portal URLs on the official TRICARE website.

TRICARE Quick Reference Contact Guide

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.