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

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## Quick answer Most TRICARE beneficiaries can visit any TRICARE-authorized urgent care center without a referral. However, Active Duty Service Members (ADSMs) are the exception and **must** have a referral or prior authorization to avoid out-of-pocket costs, unless they are using a military hospital or clinic.

Details

### Referral Requirements by Plan TRICARE’s urgent care rules depend heavily on your status and the plan you are enrolled in:

* **TRICARE Prime (and Prime Remote/Select):** Active duty family members and retirees enrolled in Prime can visit any authorized urgent care center without a referral. You do not need to call your Primary Care Manager (PCM) first. * **TRICARE Select:** No referral is ever required. You can visit any TRICARE-authorized urgent care center, though using a network provider will result in lower out-of-pocket costs. * **Active Duty Service Members (ADSMs):** You still require a referral. If you are away from your duty station and need urgent care, you should contact the Nurse Advice Line (NAL) or your PCM to secure a referral to avoid being billed under the Point-of-Service option. * **TRICARE For Life:** TRICARE acts as the secondary payer to Medicare. Medicare's rules for urgent care apply, but generally, no referral is required.

### 2026 Costs and Copayments Costs are determined by your "Group" (Group A joined before Jan 1, 2018; Group B joined on or after that date) and your sponsor status. * **Active Duty Family Members (Prime):** $0 copay at network urgent care centers. * **Retirees and their Families (Prime):** $38 copay per visit (2026 rates). * **TRICARE Select (Group A Retirees):** Approximately $35–$40 per visit; check your specific 2026 Summary of Benefits for regional variations. * **Point-of-Service (POS):** If you are in a Prime plan (non-ADSM) and choose to see a non-network urgent care provider when a network provider is available, you may be charged POS fees, which include a deductible and 50% cost-sharing.

### Finding a Provider Because the West Region transitioned to **TriWest Healthcare Alliance** as of January 1, 2025, beneficiaries in the West should use the TriWest provider directory to ensure the urgent care center is in-network. East Region beneficiaries continue to use **Humana Military**.

### The MHS Nurse Advice Line If you are unsure if you need urgent care or an Emergency Room, call the Military Health System (MHS) Nurse Advice Line at 1-800-TRICARE (874-2273), option 1. They are available 24/7 and can help ADSMs coordinate necessary referrals after hours.

## Who this affects * **Active Duty Service Members:** Restricted (referral required). * **Active Duty Family Members:** Open access (no referral needed). * **Retirees and their Families:** Open access (no referral needed). * **National Guard and Reserve:** Depends on active status or TRICARE Reserve Select (TRS) enrollment (TRS follows Select rules: no referral). * **Survivors:** Follows Prime or Select rules based on enrollment.

## Sources * **TRICARE.mil:** [Urgent Care Overview](https://www.tricare.mil/CoveredServices/IsItCovered/UrgentCare) * **Humana Military (East):** [Provider Directory and Costs](https://www.humanamilitary.com/) * **TriWest Healthcare Alliance (West):** [West Region Portal](https://www.triwest.com/en/beneficiary/) * **TRICARE Nurse Advice Line:** [MHSNurseAdviceLine.com](https://www.mhsnurseadviceline.com/)