TRICARE Prime Access to Care Standards

Seeing your provider in a timely manner is important to you – and to us. Our goal is to ensure you receive the right level of care, at the right time, by the right provider. We monitor the data every month to ensure access to care standards. If you are seeking care at a military hospital or clinic, and you can't get an appointment with your Primary Care Manager (PCM) within the standards, you will be able to get an appointment with another provider.

Types of Care

  • You'll have different access standards and rules based on the type of care you need.
  • Your costs will also vary based on type of care. Visit Health Plan Costs for more detailed cost information.  

Emergency Care

You can get Emergency Care at the nearest emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. or call 911 (or the Medical Assistance Number if overseas).

Call your PCM or regional contactor within 24 hours or the next business day.

Urgent Care

Urgent Care is care needed for conditions such as a sprain, sore throat, or fever.

You can expect to get an urgent care appointment within 24 hours (1 day), even if you are traveling.

Routine Care

Routine (primary) care includes general office visits for the treatment of symptoms, chronic or acute illnesses and diseases and follow-up care for an ongoing medical condition.

You can expect to receive a routine care appointment within 1 week (7 days).

Specialty CareSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide.

Specialty care includes any care your PCM doesn't provide (urgent, routine, preventive, and specialty care).

You can expect to get a specialty care appointment within 4 weeks (28 days).

Preventive Care

Preventive services are health screenings, tests, and examinations.

  • You'll usually get these during regular office visits.

You can expect to get an appointment within 4 weeks (28 days).

Last Updated 4/25/2024