Some TRICARE Enrollees Will Be Able to Receive Urgent Care Faster Starting in May

The Defense Department is making it easier for military family members and retirees enrolled in TRICARE Prime to access urgent care as part of a three-year pilot program.

Beginning on May 23, eligible enrollees will be able to make two urgent care visits per fiscal year to a network or TRICARE-approved provider without a referral or prior authorization. The pilot program lasts through May 23, 2019.

Urgent care is defined as a non-life-threatening injury or illness, such as a sprained ankle or high fever, which requires attention before it gets worse. It is not emergency care.  

Under TRICARE now, beneficiaries typically have two options for urgent care: they can receive it from their primary care manager, or get a referral from their PCM to obtain care from a different provider.

Besides service members’ family and military retirees, active-duty military who are stationed overseas and enrolled in TRICARE Prime Remote are eligible to participate in the pilot program. Active-duty military members are not eligible because their individual service manages their health care.

Within 24 hours of the first urgent care visit, beneficiaries should notify their primary care manager of the visit. Co-payments still apply during the visits, but there are no point-of-service fees for participants. After the pilot program visits are used, participants must have a referral from their primary care manager for any subsequent urgent care their medical professional can’t provide. Without a referral, beneficiaries will have to resort to point-of-service, which means paying more out of pocket.

Click here for more information on TRICARE’s urgent care pilot program.