FALLS CHURCH, Va. –
When a health issue comes up, knowing where to go for care can make a big difference. Whether it’s an accident or an illness, TRICARE covers a range of health care services—but the
type of care you need determines where you should go.
“The right care at the right place at the right time—that’s the goal,” said Jeannine Pickrell, M.S., RN, director for TRICARE Population Health and Disease Management, TRICARE Health Plan, at the Defense Health Agency. “Your TRICARE plan, location, and health needs all affect how and where you can get care.”
Unlock your health by understanding the types of care—and when to use them—to make better choices for you and your family.
Emergency care
If your life, limb, or eyesight is at risk, you’re having a
medical emergency. Chest pain, trouble breathing, severe bleeding, and broken bones are examples of emergencies that need immediate attention. If you reasonably believe you have an emergency, always call 911 or your international emergency number. Or, go to the nearest emergency room.
TRICARE covers emergency care anywhere in the world. You also don’t need a referral or pre-authorization to get it. However, for TRICARE Prime, you should contact your primary care manager within 24 hours—or the next business day—after receiving care. You may also need a referral for any follow-up treatment to avoid out-of-pocket costs.
Urgent care—but not an emergency
Not every issue is an emergency, but that doesn’t mean it can wait.
Urgent care is for conditions that need attention within 24 hours but aren’t emergencies.
Most TRICARE plans allow you to visit any TRICARE-authorized urgent care center without a referral, but it all depends on your plan and beneficiary group. Certain rules apply if you’re active duty or enrolled in a TRICARE overseas plan, so be sure to check ahead of time.
If you’re unsure about the seriousness of your symptoms, the Military Health System Nurse Advice Line is available 24/7. If you live overseas, call your TRICARE Overseas Program Regional Call Center.
Routine care
Routine or primary care is the foundation of everyday health. Whether it’s a
routine physical, managing chronic conditions, or a lingering cough, your PCM is your first point of contact. These providers know your medical history and can treat a wide variety of conditions and follow ups—or refer you to a specialist if needed.
Use the Find a Doctor Tool to locate a provider near you.
Specialty care
Sometimes, your health concern requires care from a provider who’s trained in a specific area of medicine. Specialists—like cardiologists, neurologists, or dermatologists—can diagnose and treat more complex conditions within their field.
Depending on your plan, you may need a referral to see a specialist. With TRICARE Prime, for example, you need a referral from your PCM. If your plan doesn’t require one, you can schedule directly with a TRICARE-authorized provider. If you’re unsure, the TRICARE Customer Service Directory is a good place to start.
(Note: If you’re enrolled in TRICARE Prime in the West Region, the specialty care referral approval waiver expired June 30. Starting July 1, you should follow all normal referral processes according to the rules of your TRICARE plan.)
Preventive care
You don’t have to be sick to see a health care provider.
Preventive care—like
cancer screenings,
immunizations, and
well-child care—are key to long-term health and readiness. Even when you feel fine, these services can catch problems early or help prevent them altogether.
TRICARE covers a wide range of preventive services. What’s more, you’ll have no cost for these services when received from a network provider, as described in the TRICARE Costs and Fees Fact Sheet.
Be prepared
It’s easier to make the right decision when you know your options ahead of time.
Unlock your health by reviewing your TRICARE plan, finding covered providers, and saving contact numbers. That way, whether it’s an emergency or a sore throat, you’ll know exactly what to do.