Eligibility first
Start with DEERS and sponsor status
TRICARE coverage starts with the sponsor and beneficiary record. Confirm DEERS is current before choosing a plan, calling providers, or assuming a family member is covered.
- Common groupsActive duty families, Guard and Reserve families, retirees, survivors, children, certain former spouses, Medicare-eligible beneficiaries, and other special categories may qualify.
- Changing statusActivation, deactivation, retirement, Retired Reserve status, Medicare eligibility, relocation, marriage, birth, adoption, divorce, or sponsor death can change the TRICARE path.
Plan paths
Match the plan to the beneficiary
Prime, Select, US Family Health Plan, overseas options, Reserve Select, Retired Reserve, TRICARE Young Adult, and TRICARE For Life serve different groups and situations.
- Active duty and familyActive duty service members generally follow Prime-style rules. Family members may have Prime, Select, overseas, US Family Health Plan, or Young Adult options depending on status and location.
- Retired and Medicare eligibleRetired families may use Prime, Select, US Family Health Plan, Select Overseas, or TRICARE For Life. Medicare Part B is usually required when TRICARE and Medicare Part A eligibility overlap.
Provider verification
Verify network or authorized status before care
TRICARE directories and rules can differ by plan, region, provider type, and location. A provider lead is not the same as official network confirmation.
- Ask billingConfirm whether the provider and exact location are network, non-network authorized, or unable to bill TRICARE for the plan and region.
- Ask about costsBefore the appointment, ask about copay, cost-share, deductible, claim filing responsibility, and any balance-billing risk.
Referrals and authorization
Do not schedule specialty care blindly
Some TRICARE plans and services require a primary care manager referral, prior authorization, or approval tied to a specific provider, NPI, service, and location.
- Get detailsAsk who requests the referral or authorization, what information is required, where it is sent, and whether you need a number before the visit.
- Check service typeSpecialty care, therapy, mental health, maternity care, procedures, imaging, medications, and durable medical equipment may have different rules.
Regional contacts
Know who handles the region
TRICARE support depends on region and coverage type. If a provider cannot verify coverage, use the official contractor or TRICARE support path.
- East and WestHumana Military handles East Region support. TriWest handles West Region support. Use the official TRICARE contact page when region or phone routing is unclear.
- For Life and overseasWPS handles TRICARE For Life in the U.S. and territories. Overseas support is routed through official TRICARE Overseas resources.
VA Companion workflow
Use this site to prepare, then use TRICARE to finalize
VA Companion keeps planning tools, provider leads, scripts, and notes together. Official TRICARE systems remain the source for eligibility, enrollment, network status, referrals, authorizations, claim disputes, and billing corrections.
- Prepare hereSearch provider leads, build the call script, identify plan and region, and write down what must be verified.
- Finalize officiallyUse TRICARE, DEERS, milConnect, or the regional contractor before relying on coverage or scheduling rules.
Related guide
Looking for CHAMPVA instead?
CHAMPVA is separate from TRICARE and is generally for eligible spouses, survivors, dependent children, and some family caregivers tied to VA program rules. Use the CHAMPVA guide when the coverage is through VA instead of the military health system.
