TRICARE Point-of-Service (POS) Fee Guide: 2026 Rates
The **TRICARE Point-of-Service (POS) option** is an additional fee charged to TRICARE Prime beneficiaries who choose to see a doctor or specialist without a required referral from their Primary Care Manager (PCM). In 2026, this results in a $300 individual deductible and a 50% cost-share for all medical services received outside of the designated referral process.
*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy and individual coverage determinations, visit TRICARE.mil.*
Details
The Point-of-Service option is essentially a financial penalty for bypassing the "managed care" aspect of the TRICARE Prime plan. While Prime is designed to minimize out-of-pocket costs by requiring referrals, the POS option allows for flexibility at a high price.
### When the POS Fee Applies You are using the POS option if you: * Are enrolled in **TRICARE Prime**, **TRICARE Prime Remote**, or **TRICARE Overseas Program Prime**. * Seek non-emergency care from a provider (network or non-network) without a referral from your PCM. * Self-refer to a specialist for a concern that has not been authorized by your regional contractor (Humana Military in the East or TriWest in the West).
### 2026 Point-of-Service Costs The POS option does not have a "catastrophic cap" for the cost-shares, meaning you could face very high bills if you use it for major procedures. For 2026, the standard costs are: * **Annual Deductible:** $300 for individuals / $600 for families. This must be paid before TRICARE pays anything. * **Cost-Share:** 50% of the TRICARE allowable charge after the deductible is met. * **Excess Charges:** If you see a non-network provider who does not accept TRICARE's negotiated rates, you may be responsible for up to an additional 15% above the allowable charge.
### Exceptions (When POS Fees Do NOT Apply) You can avoid these fees in the following scenarios: * **Emergency Care:** True emergencies never require a referral. * **Urgent Care:** Most Prime beneficiaries (excluding Active Duty Service Members) can use two visits to a network urgent care center per year without a referral, though many plans now allow unlimited network urgent care visits. * **Preventive Care:** Routine clinical preventive services from a network provider do not require a referral. * **Ancillary Services:** Diagnostic tests like X-rays or lab work generally do not trigger POS fees if the primary visit was authorized.
## Who this affects The Point-of-Service option applies only to specific beneficiary categories enrolled in Prime plans. It does **not** apply to those using TRICARE Select.
* **Active Duty Family Members (ADFMs):** Enrolled in Prime. * **Retirees and their families:** Enrolled in Prime. * **Active Duty Service Members (ADSMs):** While technically under Prime, ADSMs are generally *prohibited* from using the POS option; they must have referrals for all civilian care or they may face total denial of the claim. * **Transitional Assistance Management Program (TAMP) beneficiaries:** Enrolled in Prime.
## Sources * **TRICARE.mil:** [Point-of-Service Option](https://www.tricare.mil/Costs/HealthPlanCosts/Prime/POS) * **Humana Military (East):** [Referrals and Authorizations](https://www.humanamilitary.com/beneficiary/plans-and-programs/tricare-prime-point-of-service) * **TriWest Healthcare Alliance (West):** [Understanding TRICARE Costs](https://www.triwest.com/en/beneficiary/costs/) * **Defense Health Agency (DHA):** [TRICARE Plans Overview](https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan)