Contents
Overview
A Primary Care Manager (PCM) is the provider responsible for delivering most of your routine care under TRICARE Prime and for issuing referrals when you need to see a specialist.
MTF vs network PCMs
PCMs may be assigned at a military hospital or clinic (also called a Military Treatment Facility, or MTF) or in the civilian network managed by your regional contractor — Humana Military in the East Region or TriWest Healthcare Alliance in the West Region.
How to choose or change
You can request a specific PCM during enrollment or change PCMs at any time through milConnect, the contractor's website, or by calling them. PCM type matters: ADSMs are usually assigned to an MTF; family members and retirees can usually choose either.
Point of Service penalty
Prime's Point of Service (POS) option lets you see a non-PCM provider without a referral, but you'll pay a $328 (Group A) or $370 (Group B) annual deductible plus 50% cost-share — far more than going through your PCM.
Emergencies vs referrals
Always start with your PCM unless it's an emergency. Emergencies don't require a referral; urgent care does not require a referral but is best coordinated with the PCM or via the Nurse Advice Line (1-800-TRICARE).
Key Facts
- Category
- How TRICARE Works
- Type
- concept