What is a PCM in TRICARE?
Quick Answer
A PCM (Primary Care Manager) is the doctor or provider assigned to TRICARE Prime enrollees who coordinates all care, manages referrals to specialists, and serves as the first point of contact.
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Detailed Answer
A Primary Care Manager (PCM) is the healthcare provider who serves as the main point of contact for TRICARE Prime enrollees and coordinates all of their healthcare needs. The PCM can be a physician (MD or DO), nurse practitioner, or physician assistant at either a military treatment facility (MTF) or a civilian network practice. When enrolling in TRICARE Prime, beneficiaries either select a PCM from the available options in their area or are automatically assigned one. The PCM provides routine and preventive care, manages chronic conditions, coordinates referrals to specialists when needed, and maintains the patient's medical records. Under TRICARE Prime, most specialty care requires a referral from the PCM, which ensures care is coordinated and appropriate. Beneficiaries can change their PCM at any time by contacting their regional contractor or visiting their MTF enrollment office. Having a strong relationship with your PCM is important for receiving well-coordinated healthcare under TRICARE Prime.
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What is TRICARE Prime?
TRICARE Prime is a managed care health plan similar to an HMO that provides comprehensive coverage with a primary care manager, low out-of-pocket costs, and referrals for specialty care.
How to choose a PCM for TRICARE Prime?
Choose a PCM by reviewing available providers in your area through your regional contractor's directory, considering factors like location, specialty, office hours, and patient reviews.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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