TRICARE Toolkit: Using Urgent Care With TRICARE

TRICARE Toolkit: Using Urgent Care With TRICARE
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TRICARE-Toolkit-logo-draft.jpgMOAA’s TRICARE Toolkit provides insight and tips for navigating your TRICARE benefits. Have a question or suggestion for an upcoming column? Email beninfo@moaa.org. Read other TRICARE Toolkit columns at MOAA.org/tricaretoolkit.

 

If you have an injury or illness that isn’t quite serious enough for an emergency room visit, but you don’t want to wait to see your primary care provider, you might consider a visit to an urgent care center.

 

If you are unsure of what to do, call the Military Health System Nurse Advice Line at 800-TRICARE (874-2273). Nurses are available 24/7 to assist you in finding the care you need. If you are traveling abroad, you can find the pertinent international number at this link

 

Your status and specific TRICARE plan have different rules for getting urgent care. All beneficiaries should use a TRICARE network provider or a TRICARE-authorized (network or non-network) urgent care center to avoid additional expenses, which might not count against your catastrophic cap.

 

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Active duty servicemembers in TRICARE Prime or Overseas Prime need a referral for urgent care. Active duty servicemembers on Prime Remote do not need a referral.

 

Active duty family members in TRICARE Prime or Select do not need a referral for urgent care. Family members in TRICARE Overseas Prime or Prime Remote must get pre-authorization from the TRICARE Overseas Program contractor to ensure the urgent care visit is cashless and claimless. Without pre-authorization, you will most likely have to pay the medical provider up front and file a claim for reimbursement.

 

Retirees and family members in TRICARE Prime or Select can receive urgent care without a referral. Prime enrollees should notify their primary care managers as soon as possible about the visit.

 

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Guardmembers, reservists, and family members in TRICARE Reserve Select do not need a referral for urgent care. Retired guardmembers, reservists, and eligible family members in TRICARE Retired Reserve also do not require a referral.

 

U.S. Family Health Plan (U.S. FHP) enrollees should visit their designated provider’s website to learn how urgent care coverage works. USFHP is a TRICARE Prime option with identical co-payments.

 

Urgent Care Co-Payments

  • Active duty servicemembers/families: Prime, $0; Select, $25
  • Retirees/families: Prime, $36; Select, $34
  • TRICARE Reserve Select, $24
  • TRICARE Retired Reserve Select, $44
  • Medicare/TRICARE For Life: $0

 

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About the Author

Capt. Paul J. Frost, AFC®, USN (Ret)
Capt. Paul J. Frost, AFC®, USN (Ret)

Frost co-leads MOAA's Financial and Benefits Education program and is also an accredited Veteran Service Officer (VSO), providing VA disability compensation claim and appeal information and advice to the military community.