Navigating TRICARE: Know Your Access to Care Standards

Navigating TRICARE: Know Your Access to Care Standards
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Editor’s Note: This article is part of MOAA’s 2021-22 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Mercer Consumer. A version of the guide appeared in the November 2021 issue of Military Officer magazine.

 

TRICARE Prime families who receive medical care in military hospitals or clinics sometimes face barriers to accessing care, such as problems making appointments, so it is important to understand Prime access to care standards.

 

TRICARE Prime beneficiaries should be offered an appointment for urgent (acute) care within 24 hours, for routine care within seven calendar days, and for well-patient visits or specialty care within 28 calendar days. If your military treatment facility (MTF) cannot give you an appointment within these standards, you should be referred to the TRICARE network for care.

 

Given the many changes underway with Military Health System reform, MOAA is advocating for a more robust MTF problem reporting and resolution system that ensures the Defense Health Agency has visibility on beneficiaries’ challenges so systemic problems can be identified and addressed.

 

[RELATED: Why Fixing Gaps in Your TRICARE Coverage Remains a Top MOAA Priority]

 

This is particularly important because the new TRICARE annual enrollment requirement means TRICARE Prime patients who encounter problems at the MTF cannot just switch to TRICARE Select to transfer their care to the civilian network — they must wait for the annual enrollment period or a qualifying life event.

 

We urge military families to be patient as the entire medical system continues to grapple with the consequences of COVID-19. Many providers in both the military and civilian health care systems are facing overwhelming demand as patients try to catch up on medical care they put off during the pandemic while other factors impacting access to care continue to emerge.

 

If you encounter a problem with access to care, please let us know at legis@moaa.org. Your stories help us greatly with our advocacy efforts.

 

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About the Author

Karen Ruedisueli
Karen Ruedisueli

Ruedisueli is MOAA’s Director of Government Relations for Health Affairs and also serves as co-chair of The Military Coalition’s (TMC) Health Care Committee. She spent six years with the National Military Family Association, advocating for families of the uniformed services with a focus on health care and military caregivers.