TRICARE Appointment Guide: Booking & Access Standards
*Disclaimer: TRICARE.com is an independent reference site and is not the official TRICARE program or the Defense Health Agency. For official policy and the most current data, visit TRICARE.mil.*
## Quick answer Getting a TRICARE appointment depends on your plan and the "Access to Care" standards. TRICARE Prime users typically need a referral from their Primary Care Manager (PCM) for specialty visits, while TRICARE Select users can book directly with any TRICARE-authorized provider. All beneficiaries can schedule via the MHS GENESIS Patient Portal for military hospitals or by calling their regional contractor (Humana Military in the East; TriWest in the West).
In detail
The process for booking and attending medical appointments within the TRICARE system is governed by your specific plan and your location.
### 1. Appointment Types and Access Standards The Defense Health Agency (DHA) mandates specific "Access to Care" timeframes. If a military hospital or clinic cannot meet these, you may be authorized to see a civilian provider: * **Urgent Care:** Should be seen within 24 hours. * **Routine/Primary Care:** Should be seen within 7 days. * **Specialty Care:** Should be seen within 4 weeks (28 days). * **Wellness/Preventive:** Should be seen within 4 weeks.
### 2. How to Schedule * **Military Hospitals and Clinics:** Use the **MHS GENESIS Patient Portal** or call the local central appointment line. * **Civilian Network Providers:** Once you have a referral (if required), you call the provider's office directly to schedule. * **Nurse Advice Line:** For 24/7 guidance on whether you need an urgent appointment, call 1-800-TRICARE (874-2273), Option 1.
### 3. Referral and Authorization Requirements Requirements vary significantly by plan:
| Plan Name | PCM Needed? | Referral Required for Specialists? | Can Use Civilian Doctors? | | :--- | :--- | :--- | :--- | | **TRICARE Prime** | Yes | Yes (usually) | Only with referral | | **TRICARE Select** | No | No | Yes (any authorized provider) | | **TRICARE For Life** | No | No | Yes (Medicare-participating) |
### 4. Appointment Fees and Costs (2026 Rates) Costs are determined by your "Group" (Group A joined before Jan 1, 2018; Group B joined after) and your sponsor's status. * **Active Duty Service Members (ADSMs):** $0 for all covered appointments. * **TRICARE Prime Retirees (2026):** Small copays apply for civilian specialty visits (typically around $37–$40 per visit, varies by year). * **TRICARE Select (2026):** Active duty family members may pay a $25–$30 copay for primary care, while retirees may pay $40–$60 per visit, depending on the specific Group status.
### 5. Managing Your Regions * **East Region (Humana Military):** Covers states from Maine to Florida and west to Texas/Arkansas. * **West Region (TriWest Healthcare Alliance):** Covers the western half of the U.S., including Alaska and Hawaii. TriWest took over this region effective January 1, 2025.
## Who this applies to * **Active Duty Service Members:** Must use military clinics first and always require a referral for outside appointments. * **Active Duty Families:** Can choose Prime (managed care) or Select (flexible PPO-style care). * **National Guard & Reserve:** Applies to those on active duty orders or enrolled in TRICARE Reserve Select (TRS). * **Retirees:** Must manage copays for civilian appointments and transition to TRICARE For Life at age 65.
Common scenarios
**Scenario 1: Prime Specialist Visit** Jane is a retiree spouse on TRICARE Prime in the East Region. Her knee hurts, so she visits her PCM (copay: $25 in 2026). The PCM puts in a referral for an Orthopedist. Once Humana Military approves it, Jane schedules the ortho appointment. Because she followed the referral process, her specialty copay is approximately $40.
**Scenario 2: Select Urgent Care** Mark is an Active Duty Family Member on TRICARE Select. He wakes up with a sinus infection on a Saturday. He goes to a network Urgent Care center without a referral. Under 2026 Select rates, he pays a flat copay (typically around $30–$35 for Group B) and does not need to wait for an authorization.
**Scenario 3: The Point-of-Service (POS) Penalty** Sarah is on TRICARE Prime but decides to see a dermatologist without getting a referral from her PCM. Because she bypassed the system, she is charged "Point-of-Service" fees. For 2026, this includes a $300 individual deductible and 50% of the TRICARE allowable charge for the appointment.
## Related terms * **PCM (Primary Care Manager):** The doctor responsible for your basic care and for coordinating referrals to specialists. * **Referral:** An order from your PCM to see a specialist for a specific condition. * **Authorization:** Approval from the regional contractor (Humana or TriWest) that the care is medically necessary and covered. * **MHS GENESIS:** The electronic health record system used for booking and messaging at military facilities. * **Allowable Charge:** The maximum amount TRICARE will pay for a covered health care service.
## Sources * TRICARE.mil - Book Appointments: https://www.tricare.mil/Appointments * Humana Military (East): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West): https://www.triwest.com/ * DHA Access to Care Standards: https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Access-to-Care",faq:[{answer: