TRICARE Point-Of-Service (POS) Charge Explained | TRICARE.com

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## Definition The Point-of-Service (POS) charge is a higher out-of-pocket cost incurred when a TRICARE Prime enrollee sees a provider without a referral from their Primary Care Manager (PCM).

## What it means in practice If you are enrolled in **TRICARE Prime**, your healthcare is managed by a Primary Care Manager (PCM). To ensure your care is covered at the lowest cost, your PCM must provide a referral for most specialty care. If you bypass this process and visit a TRICARE-authorized specialist without that referral, the "Point-of-Service option" automatically kicks in.

While the POS option gives you the freedom to see almost any specialist, it comes with a significant financial penalty. You are required to pay a yearly deductible before TRICARE pays anything, and once that deductible is met, you are responsible for 50% of the TRICARE-allowable charge for all subsequent visits.

For the **2026 plan year**, the POS charges typically include: * **An individual deductible:** $300 per person. * **A family deductible:** $600 per family. * **Cost-share:** 50% of the allowable charge for medical services.

It is important to note that POS charges **do not count** toward your annual catastrophic cap. This means you could potentially pay thousands of dollars in POS fees without ever reaching the limit where TRICARE pays 100%. POS charges also apply if you seek non-emergency care at an Urgent Care Center without a referral (if your specific Prime plan requires one) or if you use a non-network provider for routine care without authorization.

## Related terms * **Primary Care Manager (PCM):** The provider responsible for coordinating your care and issuing referrals under Prime plans. * **Catastrophic Cap:** The maximum amount you pay out-of-pocket each year for covered medical services. * **Referral:** A request from your PCM for you to see a specialist for a specific medical condition. * **Network Provider:** A doctor or facility that has a contract with Humana Military (East) or TriWest (West) to provide care at discounted rates. * **Authorized Provider:** A healthcare professional or facility approved by TRICARE to provide care, though they may not be "in-network."

## Sources * TRICARE.mil: [Point-of-Service Option](https://www.tricare.mil/Costs/HealthPlanCosts/PrimeOptions/POS) * Humana Military (East Region): [Referrals and Authorizations](https://www.humanamilitary.com) * TriWest Healthcare Alliance (West Region): [Prime Beneficiary Guide](https://www.triwest.com)