TRICARE Urgent Care: 2026 Rules, Costs & Referrals | TRICARE.com

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## Quick answer Most TRICARE beneficiaries can visit a TRICARE-authorized urgent care center without a referral, though Active Duty Service Members (ADSMs) still require a referral or prior authorization to avoid out-of-pocket costs. If you are in TRICARE Prime, you should try to see your Primary Care Manager (PCM) first, but you have the flexibility to use urgent care for non-emergency issues that cannot wait until the next day.

Details

### Referral Requirements by Plan The rules for urgent care changed significantly under the "Urgent Care Pilot" which has since become permanent policy. Here is how it breaks down for 2026:

* **TRICARE Prime (Active Duty Family Members, Retirees, and others):** You do not need a referral to visit a network urgent care center. You can also visit a non-network urgent care center, but you will pay Point-of-Service (POS) charges, which are substantially higher. * **TRICARE Select / TRICARE Reserve Select / TRICARE For Life:** No referral is ever needed. You can see any TRICARE-authorized provider (network or non-network), though using a network provider will result in lower out-of-pocket costs. * **Active Duty Service Members (ADSM):** You are the only group that **must** have a referral for urgent care. If you are away from your duty station, contact the Nurse Advice Line (1-800-TRICARE) to get an authorization, or you may face a bill.

### 2026 Costs and Copays Costs depend on your "Group" (when you or your sponsor joined the military) and your specific plan. As of 2026:

* **Active Duty Family Members (Prime):** $0 copay at network urgent care centers. * **Retirees and their Families (Prime):** Approximately $38–$40 per visit at network centers (varies by year; check TRICARE.mil for exact 2026 inflation-adjusted rates). * **TRICARE Select (Group A):** Approximately $30–$35 for network visits. * **TRICARE Select (Group B):** Approximately $25–$30 for network visits.

### Network Contractors (2026) When seeking urgent care, you must ensure the facility is "TRICARE-authorized." Under the current T-5 contract: * **East Region:** Managed by **Humana Military**. * **West Region:** Managed by **TriWest Healthcare Alliance** (which replaced HNFS in 2025).

### What is "Urgent Care"? TRICARE defines urgent care as treatment for a condition that is not life-threatening but requires professional attention within 24 hours to prevent it from becoming a serious risk to your health. Examples include: * Sprains or minor broken bones (fingers/toes). * High fevers or severe sore throats. * Ear infections or urinary tract infections. * Minor cuts requiring stitches.

**Note:** If you have a life, limb, or eyesight-threatening emergency, go to the nearest Emergency Room. Emergency Room visits do not require referrals for any beneficiary category.

## Who this affects * **Active Duty Service Members:** Referral required. * **Active Duty Family Members:** No referral needed (Prime or Select). * **Retirees and their Families:** No referral needed (Prime or Select). * **National Guard and Reserve:** Use TRICARE Reserve Select rules (no referral). * **TRICARE Young Adult:** Rules follow the base plan (Prime or Select).

## Sources * **TRICARE.mil:** [Urgent Care Overview](https://www.tricare.mil/CoveredServices/IsItCovered/UrgentCare) * **Humana Military (East):** [Provider Search and Urgent Care Rules](https://www.humanamilitary.com/) * **TriWest Healthcare Alliance (West):** [West Region Benefits](https://www.triwest.com/) * **Defense Health Agency (DHA):** [TRICARE Costs and Fees](https://www.tricare.mil/costs)