TRICARE vs. TriWest: What’s the Difference?

Feb 2023 TRICARE vs. TriWest: What’s the Difference?

Their names sound similar, and they are both associated with military healthcare. But there are important differences between TRICARE vs. TriWest. If you are an active duty service member, a military veteran, a retiree of the U.S. armed forces, or a family member of someone in the previous three categories, knowing the difference between TRICARE vs. TriWest can help you get the treatment you need as quickly and efficiently as possible.

What is TRICARE?

We’ll begin our exploration of TRICARE vs. TriWest by taking a closer look at TRICARE.

TRICARE is the healthcare program that serves active duty members of the U.S. military, retirees, and family members. It is managed by the Defense Health Agency (DHA).

The U.S. Department of Defense (DoD) began to use the name TRICARE in 1996. For the prior 30 years, the program had been known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).

Active duty personnel, retirees, and eligible family members can receive healthcare at facilities that are operated by the military. When they need to access care from non-military providers, TRICARE functions as their health insurance.

As described on the program’s website, TRICARE’s scope of coverage includes:

  • Medical care
  • Dental care
  • Vision care
  • Mental health services
  • Prescription drugs
  • Reproductive health services

TRICARE also covers what the organization describes as “special needs.” This is a category of services that includes applied behavior analysis, cancer clinical trials, durable medical equipment, home health care, hospice care, and skilled nursing facility care.

What is TriWest Insurance?

The TriWest Healthcare Alliance, which is commonly shortened to TriWest, was formed in 1996 to meet the healthcare needs of active duty service members and veterans of the U.S. military. 

Since 2014, TriWest has served as the third-party administrator (TPA) for regions 4 and 5 of the Veterans Affairs Community Care Network (CCN). These regions include California, 11 other states in the western continental United States, Alaska, Hawaii, and three U.S. territories in the Pacific Ocean (Northern Mariana Islands, Guam, and American Samoa).

The Veterans Health Administration (VHA) provides healthcare services to veterans who were honorably discharged from the U.S. military, as well as current or former members of the National Guard and Reserves who were called to active duty by a federal order.

In December 2022, TriWest received the contract to manage TRICARE’s new West Region. When the next generation of TRICARE launches (which is expected to occur in 2024), TriWest will manage services in all or part of 21 states, including California. 

Military veteran using TriWest insurance to pay for rehab in California

What’s the Difference Between TRICARE vs. TriWest?

At the moment, the primary difference between TRICARE vs. TriWest is which members of the military these organizations serve. To summarize information from the previous two sections:

  • TRICARE covers active duty service members, retirees, and their family members.
  • TriWest manages care for military veterans and some members of the National Guard and Reserves.

For those who aren’t familiar with military terminology, retiree and veteran can sound like two words to describe the same people. However, this is not the case. Here’s a quick explanation: 

  • Retirees are former service members who completed a minimum of 20 years on active duty with the Army, Navy, Air Force, or Marine Corps. A person may also qualify as a retiree if they served fewer than 20 years but incurred a certain level of disability while on duty.
  • Veterans are anyone who served any amount of time on active duty with the Army, Navy, Air Force, or Marine Corps, as long as they did not receive a dishonorable discharge. This means that retirees are also veterans, but all veterans are not also retirees.

Given the amount of time they served, retirees are eligible for more benefits (such as a pension and TRICARE coverage) than are veterans who did not make a career of military service.

Before we move to the next section, we need to address one more significant current difference between TRICARE vs. TriWest:

  • TRICARE coverage follows eligible recipients wherever they are, including throughout the United States and when traveling to other nations.
  • TriWest’s services at present are limited to regions 4 and 5 of the VA’s CCN. 

Please note that the differences between TRICARE and TriWest that are described in this section will change when the new version of TRICARE takes effect, which should occur sometime in 2024.

Does TRICARE or TriWest Cover Rehab?

One similarity between TRICARE vs. TriWest is that both organizations can connect eligible members with drug and alcohol rehab services.

TRICARE’s mental health coverage includes a variety of addiction treatment services, such as:

Veterans who need residential or outpatient addiction treatment, medication-assisted treatment (MAT), relapse prevention services, or other types of care for addiction should first seek these services at a VA medical facility. If they cannot access the care they need at a VA facility, they may then turn to the Community Care Network. 

For veterans who receive addiction treatment services in regions 4 or 5 of the CCN, their care may be provided at a center that is affiliated with the TriWest Healthcare Alliance.

Begin Treatment Using TRICARE or TriWest Insurance Today

If your healthcare coverage is provided by TRICARE or managed by TriWest, and you are seeking treatment for a substance use disorder (addiction), Phoenix Rising Recovery can help. Our team can help you navigate the TRICARE or TriWest system. We will ensure you receive all benefits to which you are entitled. Once we have accomplished that, our treatment professionals can provide the customized services you need to achieve improved health and long-term recovery. Contact us today to learn more.