What is a point-of-service option in TRICARE?
Quick Answer
The point-of-service option lets TRICARE Prime enrollees self-refer to non-network providers, but with much higher deductibles (50% cost-share) and costs that do not count toward the catastrophic cap.
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Detailed Answer
The point-of-service (POS) option in TRICARE is a feature available to TRICARE Prime enrollees that allows them to seek care from non-network providers without obtaining a referral from their primary care manager. While this provides flexibility, it comes with substantially higher out-of-pocket costs. When using the POS option, beneficiaries are responsible for an annual deductible of $300 per individual or $600 per family, plus a 50% cost-share of the TRICARE-allowable amount for covered services. Additionally, POS charges do not count toward the annual catastrophic cap, meaning there is no upper limit on what beneficiaries may pay when using this option. The POS option is designed as a safety net rather than a routine way to access care, ensuring Prime enrollees are never completely denied coverage when they choose to see a provider outside the Prime network. Beneficiaries should consider using the POS option only when network options are truly unavailable or in exceptional circumstances, as the costs are significantly higher than standard Prime benefits.
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Related Questions
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.
What is the TRICARE catastrophic cap?
The catastrophic cap is the maximum amount a TRICARE beneficiary family will pay out of pocket for covered services in a fiscal year, after which TRICARE pays 100%.
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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