TRICARE is the comprehensive healthcare program for U.S. service members, retirees, and their families worldwide. Urgent care centers treat illnesses or injuries that require attention within 24 hours but are not life-threatening. Understanding TRICARE coverage for these immediate, non-emergency services is important for beneficiaries seeking care outside of a military treatment facility or their primary care manager’s office. This guide clarifies the policies, financial responsibilities, and procedural requirements for utilizing urgent care with TRICARE.
Tricare Coverage for Urgent Care Services
TRICARE covers urgent care for acute, non-emergency medical conditions. Urgent care is treatment for an illness or injury requiring prompt attention, such as a high fever, persistent sore throat, or minor sprain.
This coverage is available across all main health plans, including TRICARE Prime, TRICARE Select, and TRICARE Reserve Select. Urgent care should be sought when the condition does not threaten life, limb, or eyesight, distinguishing it from emergency room care. Seeking urgent care for minor issues is the preferred, cost-effective option.
The extent of coverage depends on the type of TRICARE plan. All beneficiaries should use a TRICARE-authorized urgent care center or network provider to receive the highest level of coverage, as using non-network providers results in significantly higher out-of-pocket costs.
Authorization and Network Requirements by Plan
The requirement for authorization or a referral varies by TRICARE plan and beneficiary category. Most TRICARE Prime enrollees, including active duty family members and retirees, do not need a referral to visit an urgent care facility, allowing direct access to care.
To maintain the lowest cost, Prime beneficiaries must use a TRICARE-authorized or network provider. Using a non-network provider typically triggers the Point-of-Service (POS) option, resulting in higher out-of-pocket expenses. Active Duty Service Members (ADSMs) in Prime must generally obtain a referral for civilian urgent care unless enrolled in TRICARE Prime Remote.
Beneficiaries enrolled in TRICARE Select, TRICARE Reserve Select, and TRICARE Retired Reserve do not need a referral for urgent care. These plans operate on a fee-for-service model, allowing beneficiaries to see any TRICARE-authorized provider. Select enrollees should confirm a provider’s network status beforehand to manage financial responsibility.
Understanding Copayments and Out-of-Pocket Costs
Financial obligations for urgent care vary based on the beneficiary category, the specific plan, and network status. Active Duty Family Members (ADFMs) enrolled in TRICARE Prime typically have a $0 copayment for in-network urgent care visits. Retirees and their family members in Prime generally have a $37 copayment for an urgent care center visit.
For those with TRICARE Select, costs include an annual deductible that must be met before cost-sharing applies, followed by a copayment for the visit. For example, an ADFM in Group B enrolled in Select pays a $19 copayment for a network visit after satisfying the deductible. A retired family member in Group B using Select typically pays a $33 copayment for the same in-network service after meeting their deductible.
Using an out-of-network provider dramatically increases these costs. For Select beneficiaries, this results in a higher cost-share, calculated as a percentage of the TRICARE-allowable charge after the deductible is met. For Prime enrollees, out-of-network use triggers POS charges, which are substantially higher than standard copayments. All urgent care expenses contribute toward the plan’s annual catastrophic cap, limiting the total amount a family must pay out-of-pocket yearly.
Locating a Tricare-Approved Urgent Care Provider
Locating an authorized provider prevents unexpected costs and ensures seamless claims processing. Beneficiaries should use the official provider directories maintained by the regional managed care support contractors: Humana Military for the East Region and TriWest Healthcare Alliance for the West Region.
These online tools allow users to search specifically for TRICARE network urgent care centers and clinics. Verifying a facility’s network status before receiving care is the most effective way to secure the lowest copayment and avoid out-of-network cost-shares. The Military Health System Nurse Advice Line is also available 24/7 to provide medical advice and help locate appropriate facilities.
When arriving for care, beneficiaries should always present their military ID and TRICARE insurance card to confirm eligibility. This helps the facility process the claim correctly. Urgent care is appropriate for conditions needing quick attention, but if a situation involves a serious threat to life or limb, visit the nearest emergency room immediately.