Bread Crumbs

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

Network: 15% of negotiated fee
Non-Network: 20% of allowable charge

Ambulatory Surgery (Same Day) $25
Behavioral Health (Inpatient) $20 per day ($25 minimum charge)
Behavioral Health (Outpatient)

Network: 15% of negotiated fee
Non-Network: 20% of allowable charge

Clinical Preventive Services

$0 for the following services:

  • Cancer screenings* (colorectal, breast, cervical, prostate)
  • Immunizations*
  • Well-child care for children under age 6 (birth through age 5)

*This includes the office visit for beneficiaries age 6 and older when a covered cancer screening or immunization is provided during the visit.

For all other preventive services:

  • Network: 15% of negotiated fee
  • Non-Network: 20% of allowable charge
DME, Prosthetic Devices, Medical Supplies

Network: 15% of negotiated fee
Non-Network: 20% of allowable charge

Emergency Services

Network: 15% of negotiated fee
Non-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 and X-ray

Network: 15% of negotiated fee
Non-Network: 20% of allowable charge

Maternity (office visits and 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)

Network: 15% of negotiated fee
Non-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

Network: 15% of negotiated fee
Non-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