Tricare beneficiaries enrolled in Prime will be able to go to an urgent care clinic without a referral under a new program that starts May 23, according to the Defense Health Agency.
An Urgent Care Pilot Program will allow military health beneficiaries in Tricare Prime, Tricare Prime Remote or Tricare Young Adult-Prime to receive care at an urgent care center without a referral up to two times a fiscal year, with Tricare picking up most of the bill.
Currently, beneficiaries can be seen for acute conditions only by their primary care manager or by referral to an urgent care center or other physician.
The Defense Department was required to create the new program under the 2016 National Defense Authorization Act. The three-year project, which will run until May 23, 2019, allows patients with a nonemergency illness or injury to be seen in their community when they can't get an appointment with their primary care doctor.
Access to timely appointments and health services has been a long-standing problem in the military health system. While a review of the system in 2014 showed that most military hospitals and clinics were meeting standards for providing appointments, military families and organizations such as the National Military Family Association have complained that the current system makes it difficult to get appointments at most military facilities and, without any choice for care during evenings and weekends, families turn to the emergency room.
The new program also is available to active-duty service members, National Guard and reserve members on orders for more than 30 straight days, if they use Tricare Prime Remote.
Beneficiaries enrolled overseas or who use the Uniformed Services Family Health Plan are not eligible for the program.
Tricare officials recommend that anyone seeking care first call the Nurse Advice Line, which may provide information on self-care as well as make referrals to urgent care if an appointment is not available at a military treatment facility.
Urgent care referrals from the Nurse Advice Line do not count toward the two-visit limit.
According to Tricare, there are no point-of-service deductibles or cost shares until after the limit is exceeded but network co-payments apply.
The limits will be counted within a fiscal year. Beneficiaries can use up to two visits from May 23 through and Sept. 30, and then their count resets for fiscal 2017, according to Tricare.
More information is available on the Tricare website.
Patricia Kime covers military and veterans health care and medicine for Military Times. She can be reached at pkime@militarytimes.com.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
