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News | Jan. 18, 2022

How to Get Urgent Care Under Your TRICARE Health Plan

By TRICARE Communications

Do you have an injury or illness that isn’t quite serious enough for a trip to the emergency room? This might be the right time to go to an urgent care center. Most TRICARE beneficiaries can go to an urgent care center whenever they need to. You just want to be sure to check out and follow the urgent care rules for your health plan. 
 
“Urgent care might be an option for you if you don’t believe you have an emergency,” said Dr. Stacy Usher, lead nurse of Clinical Oversight and Integration for the TRICARE Health Plan. “Urgent medical conditions are usually ones that aren’t considered emergencies but still require professional medical attention within 24 hours. Examples might include a small cut that might need stitches, a fever, or a sprained ankle.”
 
Emergency care means care for an illness or injury that threatens your life, limb, sight, or safety. If you reasonably believe you have an emergency, always call 911 or your international emergency number. Or, go to the nearest emergency room.
 
If you have questions about your injury or illness, you can call the Military Health System Nurse Advice Line. Nurses are available 24/7 to help you find the care you need. Are you in the U.S., Guam, or Puerto Rico? If yes, call 1-800-874-2273 and choose option 1. You can find other countries’ numbers on the website.
 
Different health plans have different rules for getting urgent care. These rules depend on your status.
 
Active Duty Service Members
Active duty service members (ADSMs) in TRICARE Prime or TRICARE Overseas Program (TOP) Prime should seek urgent care at a military hospital or clinic when available. To seek civilian urgent care, ADSMs need a referral. However, if you’re an ADSM in TRICARE Prime Remote, you don’t need a referral. In this case, you can get urgent care from any TRICARE-authorized urgent care center or network provider.
 
ADSMs must follow up with their primary care manager when they get care outside of a military hospital or clinic. This is in accordance with Department of Defense and Service regulations.
 
Active Duty Family Members
Active duty family members (ADFMs) in TRICARE Prime or TRICARE Select don’t need a referral for urgent care. When possible, you should go to a TRICARE network provider or a TRICARE-authorized (network or non-network) urgent care center. This will help you avoid more out-of-pocket costs. If you’re a family member and get urgent care from a non-network provider outside of a TRICARE-authorized urgent care center, you’ll have to pay point-of-service cost-shares.
 
Retirees and Family Members
If you’re a retiree or retiree family member in TRICARE Prime or TRICARE Select, you can get urgent care from any TRICARE-authorized urgent care center without a referral. You should see a TRICARE network provider to avoid more out-of-pocket costs.
 
National Guard, Reservists, and Family Members
National Guard, Reservists, and their eligible family members who are enrolled in TRICARE Reserve Select don’t need a referral for urgent care. Retired Reservists (including National Guard members) and their eligible family members who are enrolled in TRICARE Retired Reserve also don’t need a referral for urgent care. When possible, you should go to a TRICARE network provider. Or, you can go to a TRICARE-authorized (network or non-network) urgent care center to avoid more out-of-pocket costs. If you get urgent care from a non-network provider outside of a TRICARE-authorized urgent care center, you’ll have to pay point-of-service cost-shares.
 
Urgent Care Overseas
Are you enrolled in a TRICARE overseas plan? If you’re an ADFM seeking care overseas and are in TOP Prime or TOP Prime Remote, you must get pre-authorization from the TRICARE Overseas Program contractor. This will help make sure your urgent care visit is cashless and claimless. Without this authorization, you may have to pay the health care provider up front and file a claim for reimbursement later. If you have an overseas plan and traveling stateside, you don’t need a referral or authorization. You can get urgent care from any TRICARE-authorized urgent care center or network provider.
 
Are you enrolled in the US Family Health Plan? Go to your designated provider’s website to learn how your urgent care coverage works.  
 
Would you like to know more about your potential costs? For details about all the network and non-network costs for urgent care, you can check out the TRICARE 2022 Costs and Fees Sheet. Or, you can choose your health plan and your status on the TRICARE Costs page to see your current costs.
 
Remember, urgent care is for minor medical issues. You can search online for a TRICARE-authorized urgent care center near you. You can also call your regional contractor for help finding an urgent care center. Learn more about urgent care, so you know where and when to go if you need care.
 
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