Does a Veteran with Tricare Need a Referral to Schedule with a Primary Care Doctor?

Whether a veteran with Tricare needs a referral from the VA to schedule an appointment with a primary care doctor depends on their specific Tricare plan and situation. Here’s a breakdown:

TRICARE Prime:

  • Enrolled in a military hospital or clinic: Veterans assigned to a primary care manager (PCM) at a military hospital or clinic must schedule appointments through their PCM. They do not need a referral from the VA.
  • Enrolled with a civilian network provider: Veterans can choose their own PCM within the Tricare network. They can schedule appointments directly with their chosen PCM without a VA referral.

TRICARE Select:

  • Veterans can choose any Tricare-authorized provider, both network and non-network. For network providers, they can schedule appointments directly.
  • Non-network providers may require a referral from the VA for specific services.

TRICARE For Life:

Veterans can choose any Tricare-authorized provider, both network and non-network. They can schedule appointments directly for network providers.
For non-network providers, veterans may be able to schedule an appointment without a VA referral depending on the service needed.
Additionally:

In some cases, veterans may need a referral from the VA for specific services, even if they are enrolled in a TRICARE Prime plan and have a civilian PCM. This usually applies to specialty care or services not covered by Tricare.

Veterans can always contact their local Tricare office or visit the Tricare website for specific information and guidance regarding their situation and plan.

Here are some resources that veterans can use to find more information:

  • TRICARE Website: https://www.tricare.mil/Plans/New
  • Find/Change My Primary Care Manager: https://www.tricare.mil/GettingCare/FindDoctor/ChangePCM
  • Active Duty Service Members: https://www.tricare.mil/Plans/New
  • TRICARE Prime Access to Care Standards: https://www.tricare.mil/GettingCare/PatientResources/TRICARE-Prime-Access-Standards
  • INNOVA: https://innovallc.com/services/

It’s important for veterans to understand their specific Tricare plan and how it works to ensure they receive the care they need. If they have any questions or doubts, they should contact Tricare directly for clarification and guidance.