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Q&A: Getting Urgent Care With TRICARE

Image of Q&A: Getting Urgent Care With TRICARE. Getting sick or injured is never convenient. Fortunately, getting urgent care can take away some of the inconvenience of minor illnesses and injuries.

FALLS CHURCH, Va. – Getting sick or injured is never convenient. Fortunately, getting urgent care can take away some of the inconvenience of minor illnesses and injuries.

“Urgent care is for when you can’t wait for an appointment with your provider, but you don’t need an emergency room,” said Dr. Stacy Usher, lead nurse of Clinical Oversight and Integration for the TRICARE Health Plan.

But, before you go to your nearest urgent care center, make sure you understand your rules for getting urgent care.

“Your beneficiary category and TRICARE plan determine your rules for getting urgent care,” Usher said. “Following these rules will help you keep your out-of-pocket costs as low as possible.”

Read on to learn more about getting urgent care.

Q: How do I know if I need urgent care?

A: Urgent care is for medical conditions that aren’t emergencies but still need professional attention within 24 hours. Examples of nonemergency conditions include:

  • Cold and flu symptoms
  • High fevers
  • Minor burns
  • Sore throats
  • Sprains

Not sure if you need urgent care? The Military Health System Nurse Advice Line may be able to help. You can get health advice 24/7 from a registered nurse by phone, web chat, or video chat. If you need urgent care, the MHS Nurse Advice Line can help you find an urgent care facility.

You can use the MHS Nurse Advice Line if you live or travel in the U.S. or a country with a military hospital or clinic.

Q: Where can I get urgent care?

A: You can go to Find a Doctor or All Provider Directories to find a TRICARE-authorized (network or non-network) urgent care center or TRICARE network provider. If you’re enrolled in the  US Family Health Plan, check your designated provider’s website to learn where to get urgent care.

Urgent care is also available at some military hospitals and clinics. Go to Find a Military Hospital or Clinic to find your nearest military facility and its contact info. Call the facility or check its website to learn if it offers urgent care.

You may also be able to get urgent care via telemedicine. Call your TRICARE contractor or check its website for more info.

Q: Do I need a referral to get urgent care in the U.S.?

A: This depends on your health plan and beneficiary category. If you’re an active duty service member, you should:

  • Seek urgent care at a military hospital or clinic when available. Call the MHS Nurse Advice Line if you need medical advice or guidance on where to go for urgent care.
  • Get a referral to get civilian urgent care. However, if you’re enrolled in TRICARE Prime Remote, you can get urgent care without a referral.
  • Follow up with your primary care manager when you get civilian urgent care.

Other types of beneficiaries don’t need a referral to get urgent care.

Q: Do I need a referral or authorization to get urgent care overseas?

A: ADSMs should follow the same rules for getting urgent care overseas that they would follow in the U.S.

Active duty family members enrolled in TRICARE Prime Overseas or TRICARE Prime Remote Overseas should contact the TRICARE Overseas contractor to get pre-authorization for urgent care. This ensures that your urgent care visit is cashless and claimless. Otherwise, you may have to pay the provider up front and file a claim for reimbursement.

If you’re enrolled in TRICARE Select Overseas, you don’t need a referral or authorization to get urgent care. You should expect to pay up front for care and submit a claim for reimbursement.

Q: How do I get urgent care when traveling?

A:  If you need urgent care while traveling in the U.S. or overseas, you don’t need a referral unless you’re an ADSM. However, if you’re enrolled in a TRICARE plan stateside and you get urgent care overseas, you’ll have to pay up front and file a claim to get reimbursed. If you need help, you can call the TRICARE Overseas contractor.

Q: How much does urgent care cost?

A: Your urgent care costs depend on your health plan, your beneficiary category, and where you get care. If you’re enrolled in TRICARE Prime, point-of-service fees won’t apply when you get urgent care from a TRICARE-authorized urgent care center or a TRICARE network provider. If you seek care from a non-network provider, the usual deductible and cost-shares apply.

For details about network and non-network costs for urgent care, you can:

Don’t forget: Urgent care can be convenient for your health and your wallet by following your plan’s rules. Learn more about your urgent care options.

Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.

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