Covered Services
Learn more about what we cover -including health, dental, and pharmacy.
Urgent care is care you need for a non-emergency illness or injury. You need urgent care treatment within 24 hours, and you shouldn't have to travel more than 30 minutes for the care. You typically need urgent care to treat a condition that:
- Doesn’t threaten life, limb or eyesight.
- Needs attention before it becomes a serious risk to health.
Examples may include things like a high fever or sprained ankle.
Nurse Advice Line
Specialty Care Outpatient Visit $31 $31 Urgent Care Center Visit $31 $31 Emergency Room Visit $63 $63 Inpatient Admission (Hospitalization) $158/ admission $158/ admission TRICARE Prime Point-of-Service Option When you see a TRICARE-authorized provider other than your primary care manager for any nonemergency services without a referral, you pay. Note: Visit our Copayment and Cost-Share Information page for 2021 costs. View the cost information below for TRICARE Reserve Select (TRS) beneficiaries. The sponsor's enlistment date does not determine costs. TRS members are covered under TRICARE Select. Urgent care copay rates (Care for minor illnesses and injuries) There's no limit to how many times you can use urgent care. To be eligible for urgent care benefits, including through our network of approved community providers, you must. Be enrolled in the VA health care system, and Have received care from us within the past 24 months (2 years). Primary and Urgent Care, and Telehealth All plans Richmond: All covered services are in network Hampton Roads: HMO services are out of network. Tricare (Network Provider) Primary and Urgent Care, and Telehealth UnitedHealthcare. Primary and Urgent Care, and Telehealth MAMSI Life & Health MDIPA: Not available in Tidewater. Testing copayment waiver: Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for medically necessary COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits during which tests are ordered or administered.
If it's after hours or you're not sure if you need to see a doctor, call TRICARE's Nurse Advice Line 24/7. Call 1-800-TRICARE (874-2273) — Option 1 to talk to a registered nurse who can:
- Answer your urgent care questions
- Give you health care advice
- Help you find a doctor
- Schedule next-day appointments at military hospitals and clinics
The Nurse Advice Line is available to all TRICARE beneficiaries in the U.S. except those enrolled in the US Family Health Plan. Beneficiaries who live overseas can call the Nurse Advice Line for health care advice when traveling in the U.S., but must coordinate care with their Overseas Regional Call Center.
TRICARE Prime PlansTRICARE Prime plans include: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas and TRICARE Young Adult-Prime
If you are a(n)… | To get Urgent Care… |
---|---|
Active Duty Family Member | You don’t need a referral. |
Retiree or Retiree Family Member | |
Active Duty Service Member Enrolled in TRICARE Prime Remote | |
Active Duty Service Member Living in a TRICARE Prime Service Area1 | You should seek care at a military hospital or clinic when/where available, or contact the Nurse Advice Line for assistance. |
1If you are a family member or retiree and seek urgent care from a non-network provider outside of a TRICARE authorized urgent care center, you will have to pay point-of-service option cost-shares.
TRICARE Select and All Other TRICARE Plans
If you are a(n)… | To get Urgent Care… |
---|---|
Active Duty Family Member | You don’t need a referral. |
Retiree or their Family Member |
3You will pay network or non-network copayments or cost-shares, depending on the type of provider you see.
US Family Health Plan
If you are a… | To get Urgent Care… |
---|---|
US Family Health Plan Member | Visit your designated provider’s web site for details |
Urgent Care Overseas
If you are… | Seeking care… | To get Urgent Care… |
---|---|---|
Enrolled in TRICARE plan stateside | Overseas while traveling | You don’t need a referral. To ensure your urgent care visit is cashless and claimless, you must get prior authorization from the TRICARE overseas contractor. Otherwise, you may have to pay the provider up front and file a claim for reimbursement later. |
Enrolled in a TRICARE Overseas plan | Overseas | |
Stateside while traveling | You don’t need a referral. |
4If you are enrolled in a TRICARE Prime plan and seek urgent care from a non-network provider outside of a TRICARE authorized urgent care center, you will have to pay point-of-service option cost-shares.
5Active Duty Service Members must follow up with their PCM when they receive care outside of a military hospital or clinic, in accordance with DoD and Service regulations.
This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.
Last Updated 6/18/2020
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Mental Health Therapeutic Services
Coronavirus (COVID-19) Update:
Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. |
- TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.
- TRICARE Young Adult costs are based on the sponsor's status.
- Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost-share information, based on the TRICARE plan type.
A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:
- Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
- Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.
Tricare And Urgent Care Visits
TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)
Active Duty Family Members | Retirees and Their Family Members |
---|---|
Group A: $0 Group B: $0 | Group A: $31 Group B: $31 |
TRICARE Select (not including TRICARE Young Adult)
Tricare East Urgent Care Copay
Active Duty Family Members | Retirees and Their Family Members |
---|---|
Group A: Network Provider: $22 Group B: Network Provider: $21 | Group A: Network Provider: $30 Group B: Network Provider: $42 |
TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)
Tricare Prime Urgent Care
TRS | TRR |
---|---|
Network Provider: $21 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |
TRICARE Young Adult (TYA)
TYA Prime | TYA Select | ||
---|---|---|---|
Active Duty Family Members | Retiree Family Members | Active Duty Family Members | Retiree Family Members |
$0 | $31 | Network Provider: $21 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |