TRICARE is the U.S. military’s health insurance program, covering active-duty service members, retirees, National Guard and Reserve members, and their families. It’s authorized under Chapter 55 of Title 10 of the U.S. Code and administered by the Defense Health Agency, which delivers care through military hospitals and clinics alongside a nationwide network of civilian providers.1Office of the Law Revision Counsel. 10 U.S. Code Chapter 55 – Medical and Dental Care Rather than a single plan, TRICARE is a menu of plans with different costs, referral rules, and provider networks, and which one you can use depends on your status in the military community.
Who Can Use TRICARE
Every beneficiary has to be registered in the Defense Enrollment Eligibility Reporting System (DEERS), the database that verifies eligibility.2TRICARE. Defense Enrollment Eligibility Reporting System Active-duty service members are enrolled automatically. Family members, retirees, and other eligible people have to be added to DEERS and then enrolled in a specific plan.
Eligible dependents include spouses and unmarried children up to age 21. Full-time students at an approved college can stay covered until 23 if the sponsor provides more than half their financial support.3TRICARE. Children Dependents with qualifying physical or mental disabilities may receive extended benefits through the Extended Care Health Option, which can continue past normal age limits while the sponsor is on active duty and providing majority financial support.4TRICARE. Extended Care Health Option
A new dependent has to be added to DEERS within 90 days of the qualifying event, or 120 days for overseas beneficiaries.5TRICARE Newsroom. Getting TRICARE for Your Newborn Child Miss that window and you can end up with a coverage gap that’s hard to fix outside of open season.
Group A vs. Group B
TRICARE splits beneficiaries into two cost groups based on when the sponsor first entered service. Sponsors who entered before January 1, 2018 are in Group A, along with their families. Sponsors who entered on or after that date are in Group B.6TRICARE. How Do I Know Which Beneficiary Group I’m In Group B generally pays slightly higher enrollment fees, deductibles, and copays. Most cost figures below vary by group.
The TRICARE Plan Options
TRICARE runs several plans in parallel. What you can enroll in depends on whether you’re active duty, a dependent, retired, or serving in the Guard or Reserve.
TRICARE Prime
Prime is a managed-care plan. You’re assigned a primary care manager (PCM) at a military treatment facility or in the civilian network, and specialty care generally runs through a referral. Active-duty members are enrolled automatically; family members can choose Prime or Select.
Active-duty members need a referral for anything the PCM doesn’t provide. Other Prime enrollees need referrals for specialists and certain diagnostic services.7TRICARE. Referrals and Pre-Authorizations Outpatient mental health visits with a network provider in your region are the notable exception: no referral needed, regardless of status.8TRICARE. Do I Need a Referral for Care
Skipping the referral has consequences. If a Prime enrollee (other than an active-duty member) sees a provider without one, TRICARE treats the visit as a “point-of-service” charge. That triggers a separate annual deductible of $300 per person or $600 per family and a 50% cost-share afterward, and none of it counts toward the annual catastrophic cap.9TRICARE Newsroom. TRICARE Cost Terms – What You Need to Know About Deductibles Catastrophic Caps and Point-of-Service Fees
Retirees pay an annual enrollment fee for Prime. In 2026, Group A retirees pay $381.96 for individual coverage or $765 for a family. Group B retirees pay $462.96 individually or $927 for a family.10TRICARE. TRICARE 2026 Costs and Fees
TRICARE Select
Select works more like a traditional PPO. You can see any TRICARE-authorized provider without a referral, though network providers cost less.11Office of the Law Revision Counsel. 10 U.S. Code 1075 – TRICARE Select Active-duty family members, retirees, and their dependents are eligible.
Select has annual deductibles that vary by status and group, and after the deductible you pay flat copays for network visits or a percentage cost-share for non-network care. In 2026, active-duty family members in the E-5-and-above pay grades face deductibles of $150 per person or $300 per family in Group A, or $198 per person and $397 per family in Group B. Group A retirees pay $150/$300; Group B retirees pay $397 individually for network care and $794 for non-network care.10TRICARE. TRICARE 2026 Costs and Fees
Plans for Guard and Reserve Members
Guard and Reserve members get the same benefits as active-duty personnel when activated on orders for more than 30 consecutive days.12TRICARE. National Guard and Reserve Members and Their Family Members Off active duty, they can buy TRICARE Reserve Select, a premium-based plan that works like Select. In 2026, premiums are $57.88 per month for member-only coverage or $286.66 for member and family.10TRICARE. TRICARE 2026 Costs and Fees
Retired Reserve members not yet 60 can enroll in TRICARE Retired Reserve. Coverage mirrors Select, but premiums are substantially higher: $645.90 per month for an individual and $1,548.30 for a member and family in 2026.10TRICARE. TRICARE 2026 Costs and Fees
TRICARE Young Adult
Adult children who age out of regular eligibility at 21 (or 23 as full-time students) can buy TRICARE Young Adult coverage until 26. They must be unmarried and not eligible for their own employer-sponsored plan.13TRICARE. TRICARE Young Adult TYA-Prime costs $794 per month in 2026 and works like Prime; TYA-Select costs $363 per month and works like Select.10TRICARE. TRICARE 2026 Costs and Fees
TRICARE for Life
When retirees and their family members reach 65 and become Medicare-eligible, they shift to TRICARE for Life (TFL), a wraparound plan. Medicare pays first, and TRICARE covers the remaining out-of-pocket costs for covered services. There’s no enrollment fee, and coordination is automatic.14TRICARE. Becoming Medicare-Eligible
One requirement trips people up: you must enroll in Medicare Part B to keep TRICARE. Skip Part B and you lose TRICARE. Delay Part B and Medicare adds a permanent late-enrollment penalty of 10% on your premium for every full 12-month period you were eligible but not enrolled. The only exception is if your sponsor is still on active duty.15TRICARE. Beneficiaries Eligible for TRICARE and Medicare
What TRICARE Costs in 2026
Active-duty service members pay nothing out of pocket for covered services.16TRICARE. Health Plan Costs Everyone else pays some combination of enrollment fees, deductibles, and copays, with amounts depending on plan, group, and whether the provider is in network.
Copays and Cost-Shares
Under Prime, retirees in 2026 pay $26 for a primary care visit, $39 for specialty care, $39 for urgent care, and $79 for an emergency room visit. A network inpatient admission is $198 per stay.10TRICARE. TRICARE 2026 Costs and Fees Active-duty family members in Prime pay $0.
Under Select, active-duty family members (Group A, E-5 and above) pay network copays of $28 for primary care and $39 for specialty care. Group A retirees pay $38 for network primary care and $52 for specialty care. Non-network visits are charged as a percentage of the TRICARE-allowable amount: 20% for active-duty families and 25% for retirees.10TRICARE. TRICARE 2026 Costs and Fees
The Catastrophic Cap
TRICARE limits how much a family pays out of pocket each year. Once you hit the catastrophic cap, TRICARE covers 100% of your covered care for the rest of the calendar year. Enrollment fees, deductibles, copays, and pharmacy copays all count toward it. Point-of-service charges and premiums for premium-based plans do not.17TRICARE. Catastrophic Cap
The 2026 caps per family:
- Active-duty families, Group A (Prime or Select): $1,000
- Active-duty families, Group B (Prime or Select): $1,324
- Retirees, Group A, Prime: $3,000
- Retirees, Group A, Select: $4,381
- Retirees, Group B (Prime or Select): $4,635
Pharmacy, Dental, and Vision
TRICARE uses a three-tier pharmacy system, and where you fill a prescription matters as much as what you’re filling. Military pharmacies are free for all beneficiaries. Home delivery (up to a 90-day supply) is $14 for generic formulary drugs, $44 for brand-name formulary, and $85 for non-formulary. Retail network pharmacies (up to a 30-day supply) are $16, $48, and $85 respectively.10TRICARE. TRICARE 2026 Costs and Fees Non-network retail is the most expensive: Prime enrollees pay 50% after point-of-service deductibles, and other beneficiaries pay the greater of $48 (formulary) or $85 (non-formulary) versus 20% of total cost, after the annual deductible. Active-duty members pay nothing at military pharmacies, through home delivery, or at network retail.
Medical plans do not include routine dental care. Active-duty members get care through the Active Duty Dental Program, either at military dental clinics or, if stationed more than 50 miles from one, through civilian dentists.18TRICARE. Active Duty Dental Care Family members and retirees can buy separate coverage through the TRICARE Dental Program. Monthly premiums for 2026 start at $22.85 for family coverage of active-duty members in the E-4-and-below pay grades and reach $76.18 for family coverage of Selected Reserve members.19TRICARE. Monthly Premiums
Vision coverage is thinner. Active-duty family members get an annual routine eye exam under any TRICARE plan. Retirees in Prime get an exam every two years. Retirees on Select or TFL get no coverage for routine eye exams. Beneficiaries who want broader vision benefits can enroll in a FEDVIP vision plan during the Federal Benefits Open Season.20TRICARE. Vision
Open Season and Qualifying Life Events
TRICARE holds an annual open season from the Monday of the second full week in November through the Monday of the second full week in December. During that window you can enroll in a new plan, switch between Prime and Select, or disenroll, with changes taking effect January 1.21TRICARE. What Is the TRICARE Open Season and When Is It
Outside open season, you can only change plans after a qualifying life event (QLE). A QLE opens a 90-day window, and new coverage starts retroactively on the date of the event. Common QLEs include marriage, divorce, birth or adoption of a child, and death of a family member; retiring, separating, activating, or deactivating; moving to a new region or ZIP code; and losing or gaining other health insurance (TRICARE supplements don’t count).22TRICARE. Qualifying Life Events
Retiring members face a strict rule: enroll in a TRICARE plan within 90 days of retirement or you lose coverage, with care after that available only at military hospitals on a space-available basis.
Filing Claims and Appealing Denials
Network providers file claims directly with TRICARE, so you usually don’t have to. Non-network providers and some overseas providers may not file, which means you submit the claim yourself using DD Form 2642 with an itemized bill listing the provider’s name and address, service dates and descriptions, charges, and a diagnosis.23Department of Defense. DD Form 2642 – TRICARE DoD CHAMPUS Medical Claim Patients Request for Medical Payment Claims for care in the United States must be filed within one year of the service date (or one year from hospital discharge for inpatient care). Overseas claims have a three-year window.24TRICARE. Medical Claims
If TRICARE denies a claim, you have 90 days from the date on the explanation of benefits to appeal. Send a letter to your regional contractor with a copy of the EOB and any supporting documents. If you don’t have everything ready, file the appeal with what you have and note that more will follow. If the contractor upholds the denial, you can escalate to the Defense Health Agency for an independent review.25TRICARE. Factual Appeals
If you also carry other health insurance through an employer or a spouse, TRICARE almost always pays second, after the other plan processes the claim.26TRICARE. Using Other Health Insurance Active-duty members are the exception worth knowing: if you’re on active duty and use your other coverage, TRICARE will not act as second payer, and you’re responsible for whatever the other insurer doesn’t cover.