Point of Service

Point of Service (POS) is an option available to TRICARE Prime enrollees that allows them to receive non-emergency care from any TRICARE-authorized provider without a referral from their Primary Care Manager. Using the POS option means significantly higher out-of-pocket costs compared to staying within the Prime referral system.

How POS works: • You seek care from a provider without a referral • TRICARE covers the care under POS rules • You pay higher deductibles and cost-shares • The care still counts as TRICARE-covered

POS cost implications: • Annual deductible of $300 individual / $600 family • 50% cost-share after deductible (compared to small copays with referrals) • POS costs do NOT count toward the catastrophic cap • You may also face balance billing from non-network providers

When POS might be used: • You need specialty care but cannot get a timely referral • You prefer a specific provider not in the Prime network • You need care while traveling outside your Prime Service Area

POS provides an important safety valve for Prime enrollees who need flexibility, but the significantly higher costs mean it should be used judiciously. Getting a referral through your PCM is almost always more cost-effective.