There’s a lot to consider when you pick a doctor. If you’re enrolled in TRICARE, the type of provider you select can affect your out-of-pocket costs. People who aren’t aware of the issues can be surprised by unexpected bills. It can also impact how claims are filed. Here’s what everyone should know before their doctor’s visit.
Network, Non-Network, Participating and Non-Participating Providers
TRICARE-authorized providers can be network or non-network. Additionally, they can be participating or non-participating.
Network providers, also called in-network providers, are ones who have signed an agreement stating that they will accept payment from TRICARE plus any required out-of-pocket expenses as the full payment for services. The agreement also states that the provider will file claims on the patient’s behalf, although overseas providers do not have to file claims in all situations.
Non-network providers, also called out-of-network providers, have not signed this agreement. However, some of these non-network providers are participating. This means that they will still accept payment from TRICARE plus any required out-of-pocket expenses as the full payment for services, and that they will file claims on the patient’s behalf. However, the required out-of-pocket costs may be higher.
Non-participating providers, on the other hand, may charge more for services. Additionally, you may have to pay for the services upfront and then file a claim for reimbursement.
| Participating | Non-Participating | |
| Network |
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N/A |
| Non-Network |
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Controlling Costs
One way to avoid paying higher costs is to stick to network providers. To find network and participating providers, visit www.tricare.mil.
Another way is to select the best plan type for your situation. In addition to selecting the best plan type – such as TRICARE Prime or TRICARE Select – you can consider a TRICARE Supplement plan.
The TRICARE Supplement is designed to work with other TRICARE plans to help enrollees manage out-of-pocket costs. When combined with TRICARE Select, TRICARE Supplement offers up to 100 percent coverage after deductibles and enrollment fees. TRICARE Supplement pays benefits whether or not the provider participates with TRICARE.
Learn more about how to reduce your out-of-pocket costs by combining TRICARE and a TRICARE Supplement by watching the video below. And, make sure to also download our free Buyer’s Guide.
