TRICARE Point of Service (POS) Explained | 2026 Costs | TRICARE.com

*TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and the most current data, visit TRICARE.mil.*

## Definition The Point of Service (POS) option allows TRICARE Prime enrollees to see any TRICARE-authorized provider without a referral, but at the cost of significantly higher out-of-pocket deductibles and cost-shares.

## What it means in practice If you are enrolled in a TRICARE Prime plan (including Prime Remote or Prime Overseas), your coverage typically requires you to get a referral from your Primary Care Manager (PCM) before seeing a specialist. If you bypass this step and see a specialist—or any other authorized provider—without that referral, TRICARE will process the claim under the **Point of Service** option.

Using the POS option is expensive. Instead of the small copays associated with Prime, you must first meet a specific POS deductible. For the 2026 plan year, these deductibles are typically **$300 for individuals and $600 for families**. Once the deductible is met, you are responsible for a cost-share of **50% of the TRICARE-allowable charge**. Furthermore, any costs you pay under the POS option do **not** apply toward your annual Catastrophic Cap, meaning there is no upper limit on how much you might pay out-of-pocket for that care.

There are certain scenarios where the POS option does not apply. You do not need a referral for emergency care, clinical preventive services from a network provider, or the first eight behavioral health visits per year (for most beneficiaries). However, for routine specialty care, using POS can result in bills totaling hundreds or thousands of dollars more than a standard referral-based visit.

Technically, the POS option is not available to Active Duty Service Members (ADSMs). ADSMs must always have a referral for specialty care; if they seek care without one, the claim may be denied entirely rather than being paid at the POS rate, potentially leaving the service member responsible for 100% of the bill.

## Related terms * **Primary Care Manager (PCM):** The doctor or clinic responsible for providing your basic care and coordinating referrals to specialists. * **Referral:** A request from your PCM to the regional contractor (Humana Military or TriWest) asking for authorization to see a specialist. * **Authorized Provider:** A doctor, hospital, or clinic that has been approved by TRICARE to provide care to beneficiaries. * **Catastrophic Cap:** The maximum out-of-pocket amount a family pays for TRICARE-covered services each year. * **Cost-Share:** The percentage of the total cost of a covered health care service you pay after you've paid your deductible.

## Sources * TRICARE.mil: Point of Service Option [https://www.tricare.mil/Costs/HealthPlanCosts/PrimeOptions/POS](https://www.tricare.mil/Costs/HealthPlanCosts/PrimeOptions/POS) * TRICARE.mil: Referrals and Pre-authorizations [https://www.tricare.mil/referrals](https://www.tricare.mil/referrals) * TriWest Healthcare Alliance (West Region Contractor) [https://www.triwest.com](https://www.triwest.com)