TRICARE is the health care program for U.S. military service members, retirees, and their families. It covers more than 9 million people through a combination of military hospitals and clinics (called Military Treatment Facilities) and civilian provider networks. Your specific plan options and costs depend on your military status: whether you’re active duty, retired, in the National Guard or Reserve, or a family member of someone who serves.
Who Is Eligible for TRICARE
Eligibility starts with the “sponsor,” the person who serves or served in a uniformed service. Sponsors include active duty members, retirees, and National Guard and Reserve members. Spouses and children of sponsors are also eligible as long as they’re registered in the Defense Enrollment Eligibility Reporting System (DEERS), the military’s database for tracking who qualifies for benefits.
TRICARE itself doesn’t decide eligibility. The sponsor’s branch of service makes that determination and reports it to DEERS. If you’re not showing up as eligible, the fix starts with your service branch’s personnel office, not with TRICARE.
The Two Main Plans: Prime and Select
Most TRICARE beneficiaries choose between two core plans, and the difference comes down to how much flexibility you want versus how much you’re willing to manage.
TRICARE Prime works like an HMO. You’re assigned a primary care manager (PCM), either at a military facility or a civilian network provider, who coordinates all your care. To see a specialist, your PCM submits a referral, and your regional contractor pre-authorizes the visit. Active duty service members need referrals for almost any care outside their assigned military facility, including urgent, routine, and preventive care. Other Prime enrollees need referrals specifically for specialty care and some diagnostic services. The tradeoff for this gatekeeping is lower costs: active duty families pay no enrollment fees, and retiree families pay $744 per year for family coverage under Group A (those who first joined before 2018) or about $901 under Group B.
TRICARE Select works more like a PPO. You can see any TRICARE-authorized provider without a referral, though you’ll pay more out of pocket for the freedom. Active duty families still pay no enrollment fees. Retired families pay $365 per year (Group A) or $1,159 (Group B) for family enrollment, plus annual deductibles before cost-sharing kicks in.
Group A vs. Group B
You’ll see these labels throughout TRICARE’s cost tables. Group A includes sponsors who first entered service before January 1, 2018. Group B covers everyone who joined on or after that date. Group B generally pays somewhat higher fees and deductibles, a change Congress made as part of military health care reform.
What You’ll Pay Out of Pocket
Active duty service members pay nothing. Their health care is fully covered. The costs below apply to their family members and to retirees.
For active duty family members in 2025, there are no enrollment fees for either Prime or Select. Select enrollees pay annual deductibles that range from $50 to $386 depending on rank and Group status. The annual catastrophic cap, the most you’d ever pay in a year, is $1,000 for Group A and $1,288 for Group B regardless of plan.
Retirees and their families pay more. Prime enrollment runs $372 to $450 per year for an individual. Select enrollment ranges from about $182 (Group A) to $579 (Group B) individually. Annual deductibles for Select run $150 to $386 for individuals using network providers, doubling for families. The catastrophic cap for retirees tops out at $3,000 to $4,509 depending on the plan and group, so even in a year with major medical needs, your total spending is capped.
How Referrals and Pre-Authorization Work
If you’re on TRICARE Prime and need to see a specialist, your primary care manager starts the process. They submit a referral to your regional contractor, who pre-authorizes the visit, both steps typically happening together. You don’t need to file separate paperwork for each step.
Certain services always require pre-authorization regardless of plan: home health services, hospice care, organ transplants, applied behavior analysis, and some dental procedures. If you skip the authorization step and see a non-network provider without approval, you’ll face point-of-service fees that can significantly increase your share of the bill.
TRICARE Select enrollees generally skip the referral process and go directly to any TRICARE-authorized provider, which is one of the plan’s main advantages.
Two Regions, Two Contractors
TRICARE divides the country into two regions, each managed by a private contractor that builds and maintains the civilian provider network. As of January 2025, Humana Military manages the East Region and TriWest Healthcare Alliance manages the West Region. Six states shifted from East to West as part of this transition.
If you’re in the West Region, TriWest accepted all unexpired referrals and authorizations that were previously approved by the old contractor, so ongoing care wasn’t interrupted. Your regional contractor is your main point of contact for finding network providers, managing referrals, and resolving claims issues.
Getting Care: Military Facilities vs. Civilian Providers
TRICARE delivers care through two channels. “Direct care” means treatment at a Military Treatment Facility like a base hospital or clinic. “Purchased care” means visits to civilian doctors and hospitals in the TRICARE network. In practice, most beneficiaries use a mix of both.
Military facilities prioritize active duty members first. Retirees and family members can receive care there when space is available, and some facilities offer a program that lets eligible beneficiaries enroll specifically for primary care at that facility. When a military facility can’t provide what you need, whether due to capacity or specialty availability, you’re referred into the civilian network.
Prescription Drug Coverage
TRICARE covers prescriptions through three channels: military pharmacies on base (where most drugs are free), home delivery through the TRICARE mail-order pharmacy, and retail network pharmacies.
The cost differences are significant. For a 90-day supply through home delivery, you’ll pay $14 for a generic, $44 for a brand-name formulary drug, and $85 for a non-formulary drug. At a retail pharmacy, a 30-day supply costs $16 for generics, $48 for brand-name, and $85 for non-formulary. If you take maintenance medications, home delivery is almost always the better deal since you get three times the supply for a similar copay.
Medically retired service members and survivors of active duty members get reduced pharmacy costs, with generics free through home delivery and brand-name drugs at $20 for a 90-day supply.
Plans for Guard, Reserve, and Retirees Over 65
National Guard and Reserve members who aren’t on active duty orders can purchase TRICARE Reserve Select, a plan similar to TRICARE Select with monthly premiums. This gives drilling reservists and their families access to the full TRICARE network without needing to be on active duty.
Once you turn 65 and enroll in Medicare, your coverage shifts to TRICARE For Life. This program acts as a supplement that wraps around Medicare. Medicare pays first, then TRICARE For Life picks up most or all of the remaining costs. For services that both programs cover, you’ll typically pay nothing out of pocket.
The key requirement: you must have both Medicare Part A and Part B. Dropping Part B means losing TRICARE For Life eligibility, even if you live overseas where Medicare doesn’t provide coverage. There’s no enrollment fee for TRICARE For Life itself, but you do pay standard Medicare Part B premiums. Coverage starts automatically once both parts of Medicare are active.
Dental and Vision Coverage
TRICARE’s medical plans don’t include routine dental or vision care for most beneficiaries. Instead, these are handled through the Federal Employees Dental and Vision Insurance Program (FEDVIP), which offers separate plans you can purchase during open enrollment.
Retired service members, Guard and Reserve members (including “gray-area” retirees under 60), and their families can enroll in FEDVIP dental coverage. Vision coverage through FEDVIP is available to those groups if they’re enrolled in a TRICARE health plan, and also to active duty family members enrolled in TRICARE. Active duty service members themselves receive dental care through their branch of service.