Tagovailoa led the league in passer rating in 2022 and passing yards in 2023, earning Pro Bowl honors in the latter, and helping the Dolphins qualify for the playoffs both seasons.

[22] He threw the game-winning 41-yard touchdown pass in overtime to another true freshman, wide receiver DeVonta Smith as Alabama defeated Georgia, 26–23, claiming their 17th National Championship.

[25] After winning the National Championship, Tagovailoa emphasized how important it was to him to make his home state of Hawaii proud of his success on the football field.

[27] During Alabama head coach Nick Saban's weekly Monday press conference following the victory, he announced Tagovailoa as the starter for the Crimson Tide's home opener against Arkansas State on September 8.

[43] He underwent surgery to repair the ankle the following day, and did not play in the next game against Arkansas (a 48–7 victory led by quarterback Mac Jones).

[47] In the Tide's matchup against Mississippi State, Tagovailoa led the team to a 35–7 lead (14-of-18, 256 passing yards, two touchdowns) before leaving the game after a sack that saw his knee driven into the ground, causing his hip to dislocate and fracturing the posterior wall of his acetabulum, as well as suffering a broken nose and concussion.

[62] He passed his physical with the team in July 2020 to begin training camp,[63] but was named the backup to Ryan Fitzpatrick to start the season.

[64] Tagovailoa made his debut appearance in a Week 6 game against the New York Jets, coming in relief of Fitzpatrick in the fourth quarter of a 24–0 win where he threw two passes for nine yards.

[72][73] In Week 16 against the Las Vegas Raiders, Tagovailoa threw for 94 yards and a touchdown before being benched in favor of Fitzpatrick again in the fourth quarter.

[74] In Week 17 against the Buffalo Bills, needing a win for the Dolphins to qualify for the playoffs, Tagovailoa threw for a career-high 361 yards, one touchdown, and three interceptions as Miami lost 56–26.

[82] In their next game against the Baltimore Ravens, Tagovailoa came off the bench to energize the Dolphins, completing 8 of 13 passes for 158 yards and a rushing touchdown, resulting in an upset 22–10 victory.

Following their loss, and with the Los Angeles Chargers defeating the Broncos, the Dolphins were eliminated from playoff contention for the fifth consecutive year, and 18th time in 20 seasons.

[90] During the offseason previous to the 2022 season, the Miami Dolphins fired head coach Brian Flores, arguing internal communication issues.

The Dolphins hired Mike McDaniel as their head coach on February 6, 2022, who expressed unbridled support for Tagovailoa as his starting quarterback.

Tagovailoa demonstrated a fencing response and was stretchered off the field and transported to the University of Cincinnati Medical Center with head and neck injuries.

[104] Two days later, the NFL players' union fired their independent neurotrauma consultant who was involved in Tagovailoa's concussion check during the Bills game.

[116] On January 11, McDaniel said that Tagovailoa had not been cleared to return to practice since he entered concussion protocol a second time, and was ruled out for his third consecutive game.

[130] Tagovailoa made his playoff debut against the Chiefs in the Wild Card round, throwing for 199 yards with one touchdown and one interception in a 26–7 loss.

[134] During Thursday Night Football on September 12, Tagovailoa suffered another concussion against the Bills after leading with his helmet into contact with safety Damar Hamlin following a scramble.

Head coach Mike McDaniel confirmed that medical experts approved his return, and Tagovailoa stated that he did not consider retirement after the concussion.

[136] On October 27, Tagovailoa made his return in Week 8 against the Arizona Cardinals, completing 28-of-38 passes for 234 yards and a touchdown as the Dolphins lost on a walk-off field goal, dropping their record to 2–5.

[137] The following week against the Bills, Tagovailoa completed a career-best 89.3% of his passes (25-of-28) and led a game-tying touchdown drive with under two minutes left, but the Dolphins lost on another last-second field goal.

[138] Tagovailoa helped snap a three-game losing streak with timely third-down throws, going 9-of-12 for 137 yards on third down in a 23–15 win over the Los Angeles Rams.

[139] He continued his efficient play against the Raiders and Patriots, completing over 70% of his passes for 605 yards, seven touchdowns, and no interceptions across the two games as Miami improved to 5–6.

His awareness while scanning the field, avoiding defenders in the pocket and running have been highly touted,[143] with one source endearingly calling it his "Spidey-sense" in reference to the superhero Spider-Man.

[148] Since taking over as head coach, Mike McDaniel has utilized Tagovailoa's fast processing and decision-making skills as an integral part of the Dolphins' offense, which has relied heavily on rhythm, timing, fast receivers such as Tyreek Hill and Jaylen Waddle, and pre-snap assessment, allowing Tagovailoa's further development as a pocket passer.

[153][154] Although Tagovailoa is predominantly right-handed, his father trained him to throw the ball with his left hand as a child, because he wanted a left-handed son.

[158] In February 2021, Tagovailoa announced the establishment of the Tua Foundation, a nonprofit dedicated to the support of youth initiatives, health and wellness, and other charitable causes.

[160] In recognition of the foundation launch, three grants of $16,667 (totaling $50,000) were awarded on February 4 to the Police Athletic League of North Miami, Big Oak Ranch in Springville, Alabama, and the Polynesian Football Hall of Fame in Honolulu.

[165] On May 19, 2018, Tagovailoa returned to Hawaii after winning the National Championship game with Crimson Tide teammate and friend Najee Harris to be celebrated at the Hometown Hero Parade.