Do I Need a Referral for Mental Health with TRICARE?
By: Gina Romero, LICSW, LCSW. Current TRICARE provider and AD military spouse.
Myth or Fact? A referral is never needed for mental health therapy with TRICARE.
→ While this is a commonly held belief among TRICARE beneficiaries, this is actually a myth!
Navigating TRICARE’s referral requirements can be confusing. And when you're already dealing with the stress of trying to get mental health support, the confusion can be a deterrent in getting the support that you need. Whether you're a servicemember, spouse, retiree, or dependent, understanding how your TRICARE plan works—and whether you need a referral to see a therapist—is key to getting the care you need quickly without unexpected costs.
Let’s break it down: the need for a referral depends on which TRICARE plan you have and the type of provider you want to see. Here’s what you need to know:
TRICARE Providers: Who You See Matters
Even if your plan doesn’t require a referral, the type of provider you see can change things. Below, I’ll break down the types of TRICARE and Non-TRICARE providers.
In-Network Providers
Contracted with TRICARE.
If you have TRICARE Select: No referral needed for mental health therapy
If you have TRICARE Prime: A referral is not needed for mental health therapy if you have Prime or Select
Certified Non-Network Providers
Not in TRICARE’s network, but still authorized to bill TRICARE.
If you have TRICARE Select: No referral needed.
If you have TRICARE Prime: Referral is required. Even for virtual therapy.
Note that there are two types of Certified Non-Network Providers: Participating and Non-Participating.
Participating Providers bill TRICARE in the same way that In-Network providers do. They bill you your copay (if you have one), and you’re not charged additional costs.
Non-Participating Providers can legally charge you up to 15% more than the CMAC rates. They will also typically charge you up front, and provide you with an invoice (called a Superbill) that you can submit to your insurance for reimbursement. Here’s an example: the CMAC rate is $117 where you live. You are billed $134.55 by your provider, and TRICARE reimburses you $27. Your total out-of-pocket cost per session is $44.55.
Out-of-Network Providers
These providers are not actually TRICARE providers, but I’m including this for clarity
Out-of-Network Providers have no affiliation with TRICARE
They will bill you their full rate, often $150-200, depending on the market rate in your area
You are not eligible for reimbursement from an Out-of-Network Provider
Pros:
TRICARE will never know your diagnosis, and you actually aren’t required to have one
Session length and frequency isn’t determined by TRICARE
🔎 Tip: TRICARE’s directory is often outdated. Try searching Psychology Today and filter by “TRICARE” to find therapists in your area.
TRICARE Plans: Who Has What—and When Referrals Are Required
There are multiple types of TRICARE plans, and each has different rules around referrals. Here's a detailed breakdown:
TRICARE Prime
Who has it: Active duty service members (ADSMs), retirees under age 65, some Guard/Reserve members and families, survivors, and former spouses. If you’re the spouse or family member of an Active Duty Servicemember and on Prime, this is the type of Prime that you have.
Referral needed? Yes, in most cases. You’ll typically receive care at a military treatment facility (MTF) or from an in-network provider.
→ If you want to see a Certified Non-Network therapist, a referral is required.
TRICARE Prime Remote
Who has it: ADSMs and families stationed far from an MTF.
Referral needed? Yes, even though you're not near a base, you still need a referral to see a specialist or mental health provider.
TRICARE Select
Who has it: Active duty family members, retirees under 65 and their families, Guard/Reserve members not on active duty. If you’re the spouse or family member of an Active Duty Servicemember with Select, this is the type of Select that you have.
Referral needed? No. You can see any TRICARE-authorized provider (in-network or Certified Non-Network) without a referral. You may pay higher out-of-pocket costs if the provider is Non-Participating
TRICARE Reserve Select (TRS)
Who has it: Guard/Reserve members and families (not on active orders).
Referral needed? No.
TRICARE Retired Reserve (TRR)
Who has it: Retired Guard/Reserve members under age 60 and their families.
Referral needed? No.
TRICARE for Life (TFL)
Who has it: Retirees and their families eligible for Medicare (usually 65+).
Referral needed? No, but Medicare is the primary payer. TRICARE acts as secondary coverage. You’ll need to find a provider who accepts BOTH TRICARE and Medicare.
TRICARE Young Adult (TYA)
Who has it: Dependents aged 21–26.
Referral needed? Depends on plan choice.
→ TYA Prime = Yes
→ TYA Select = No
US Family Health Plan (USFHP)
Who has it: Some retirees and active duty family members in select areas.
Referral needed? Typically yes, depending on the network rules.
TRICARE Prime Overseas & Prime Remote Overseas
Who has it: ADSMs and their command-sponsored families living overseas.
Referral needed? Yes.
TRICARE Select Overseas
Who has it: Retirees and family members living overseas.
Referral needed? No.
Active Duty? You Always Need a Referral
If you're an Active Duty Service Member (ADSM), you’ll always need a referral for any civilian mental health care if you want TRICARE to cover the cost. If you want mental healthcare and prefer to cover the cost yourself, you can always pay an Out-of-Network provider out of pocket. If you want support covering the cost but don’t want TRICARE to be involved, consider using one of the resources below:
Military OneSource
12 free counseling sessions (per issue) for service members and families.
No referral or diagnosis required.
➡️ militaryonesource.mil
Centerstone Military Services
Free, confidential mental health support for veterans, active duty, and families. ➡️ centerstone.org/military-services
Services depend on availability of providers, and are not always available
Vet Centers
Free counseling for veterans and their families, including marriage and family therapy.
➡️vetcenter.va.gov
Wandering Pine Wellness: Here to Help
At Wandering Pine Wellness, we work with TRICARE and offer online therapy for clients in Washington, Colorado, and Nevada, and in-person therapy in Las Vegas. We can help you figure out your benefits, referral needs, and connect you with a provider who understands both your mental health and the realities of military life. If none of our therapists are a good fit for you, we will help you find a therapist who is. Get started by filling out our Appointment Request Form!
