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Cost Shares for Active Duty Family Members

  • You'll pay a cost share based on the type of care and provider you see (network vs. non-network).
  • Non-network providers may charge up to 15% more than the TRICARE allowable charge.
  • You're responsible for these extra charges. 
  • Some inpatient cost shares will change each fiscal year, starting October 1.

These costs are effective 10/1/2014.
Service Cost
Ambulance Services In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
Ambulatory Surgery (Same Day) $25
Behavioral Health (Inpatient) $20 per day ($25 minimum charge)
Behavioral Health (Outpatient) In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
Clinical Preventive Services $0 for colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6.

For all other preventive services:
In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
DME, Prosthetic Devices, Medical Supplies In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
Emergency Services In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care) $17.80 per day ($25 minimum charge)
Immunizations $0
Laboratory & X-ray In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting) $17.80 per day ($25 minimum charge)

Note: This is one global fee for all of the maternity care and delivery.
Maternity (office visits for delivery planning in a TRICARE-authorized birthing center) $25
Maternity (office visits for delivery planned at home or other setting) In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
Newborn Care The lower of the number of hospital days minus three multiplied by $17.80, or 25% of the total billed charges.

Note: If any family member is enrolled in TRICARE Prime, the newborn is also covered by Prime for up to the first 60 days and costs are $0.
Outpatient Visit In-Network: 15% of negotiated fee / Out-of-Network: 20% of allowable charge
Skilled Nursing (Inpatient) $17.80 per day ($25 minimum charge)

Only available in the U.S. and U.S. Territories.
Enrolled in TRICARE Young Adult?

Newborn care is not covered unless the father of the child is a uniformed service member.

Last Updated 1/26/2015