TRICARE Prime Access Standards

         
The Care Is There When You Need It
In addition to paying the lowest out-of-pocket costs compared to all the other TRICARE program options, another benefit of enrollment in TRICARE Prime is that you are assured access to care when you need it.

In most cases, TRICARE Prime beneficiaries will receive care at a military treatment facility (MTF). However, there are two instances when that may not be possible: 1) when there is no MTF nearby and 2) when you are unable to get an appointment due to a high demand for services.

TRICARE Prime access standards are specified in the Code of Federal Regulations to ensure that you are able to receive timely care under any circumstance. These standards regulate the amount of time that you will have to wait and the distance that you will have to travel to receive treatment.

TRICARE Prime access standards entitle you to receive:

• An urgent care appointment within 24 hours
• A routine care appointment within one week
• A specialty care appointment within four weeks

Under normal circumstances, you should have no more than a 30-minute drive to an MTF to see your primary care manager (PCM) for routine care, and no more than an hour’s drive for specialty care. When this is not possible, you may obtain a referral to visit a TRICARE network provider for treatment.

If your PCM is not available within the timeframes specified in the access standards, he or she will refer you to another provider. Note: If you choose to see another provider for care without a referral from your PCM, the services will be reimbursed under the point of service option, which has a deductible and higher out-of-pocket costs.