MAY 11, 2023 – Are you enrolled in a TRICARE Prime plan? Whether you’re a new or longtime enrollee, you need to know about your primary care manager (PCM). Your PCM is the health care provider you’ll visit for most of your care.
“Everyone enrolled in a TRICARE Prime plan will have a primary care manager,” said Shane Pham, program analyst with TRICARE Health Plan’s Policy and Programs Section at the Defense Health Agency. “Depending on your status, you may have the option of choosing your own TRICARE network provider or having one assigned to you.”
Read on to learn about the role your PCM will play in your health care and your options for choosing or changing your PCM.
Role of PCMs
Your PCM is responsible for your routine health care. Active duty service members (ADSMs) should see their PCM for urgent care too. For specialty care, your PCM will give you a referral to see other providers. Remember, if you don’t get a referral for specialty care, your care will be under the point-of-service (POS) option. By using the POS option, you’ll pay higher out-of-pocket-costs.
How TRICARE Assigns PCMs
As noted in the TRICARE Plans Overview Fact Sheet, your PCM may be a military or civilian provider. You may be required to enroll with your local military hospital or clinic. US Family Health Plan enrollees need their own primary care provider within their plan’s network.
There are certain rules TRICARE must follow to assign you a PCM:
- TRICARE can’t assign a PCM located more than 100 miles from your address on file in the Defense Enrollment Eligibility Reporting System (DEERS). Make sure you keep your address updated in DEERS.
- TRICARE can’t assign you to a military hospital or clinic located more than 100 miles from your address without Defense Health Agency approval.
- Any civilian PCM must be a TRICARE network provider within a Prime Service Area.
“If you move to a new area or region, you must update your address in DEERS and request a new PCM assignment,” Pham said. “This is to ensure you’re meeting TRICARE access-to-care policies. If you don’t do this, you may be disenrolled from your TRICARE health plan.”
Changing your PCM
If you already have a military hospital or clinic PCM, you may choose a new military PCM at any time, depending on the capacity and guidelines of your military hospital or clinic. This may not apply to ADSMs.
If you want to change to a civilian PCM, you can also change at any time, but you must find a provider in the TRICARE network. You can search your region’s provider directory to find a new PCM. Check out the East Region provider directory or West Region provider directory online. If you live overseas, call your TRICARE Overseas Program Regional Call Center for guidance on switching your PCM.
In general, you can request a PCM change in three ways:
- Online: Submit your PCM request online through Beneficiary Web Enrollment at milConnect.
- By phone: Call your regional contractor or US Family Health Plan provider.
- By mail: Send DD Form 2876 to your TRICARE regional contractor. Be sure to complete the sponsor section, the section about the PCM change, and the signature section.
Once your regional contractor processes your request, they’ll notify you of your PCM change. Remember that you shouldn’t seek services until you receive confirmation of this change.
Your primary care manager is your first line of defense when it comes to your health. Remember to schedule your next routine checkup and speak to your PCM about any health issues on your mind. If you want to learn more about PCMs, visit Find/Change My Primary Care Manager.
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Courtesy Story
Defense Health Agency