Structure
Regional contractors change. TRICARE contracts are periodically re-competed and reassigned, and regions have been reconfigured. Confirm the current contractor for your region before enrolling rather than relying on a saved reference.
Plan types
TRICARE Prime (managed care, requires a primary care manager and referrals), TRICARE Select (preferred provider option), TRICARE For Life (for Medicare-eligible beneficiaries, wrapping around Medicare), and several specialized programs.Enrollment
Through the regional contractor. Network participation is separate from being an authorized non-network provider — TRICARE distinguishes between network and non-network authorized providers, with different payment and beneficiary cost-share consequences.Referrals and authorization
TRICARE Prime is referral-driven. Care generally requires a referral from the beneficiary’s primary care manager, and specialty care frequently requires authorization from the regional contractor. Delivering care without a required referral or authorization commonly results in non-payment, and the beneficiary may bear a higher cost-share. Verify the referral before the visit.Timely filing and appeals
Set by program rules rather than individual contract. Confirm current requirements with the regional contractor.Quirks worth knowing
- TRICARE For Life coordinates with Medicare — Medicare pays first, TRICARE second, for Medicare-eligible beneficiaries
- Beneficiary categories matter — active duty, active duty family member, retiree, and others have different rules
- The program is federal, so state insurance law generally does not apply
- Rates are generally benchmarked to Medicare