Cost Shares for All Others

You'll pay a cost share based on the type of care 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. The costs below start October 1, 2013.

Type of Care Network Non-Network
Ambulatory Care (Same Day Surgery) 20% of the negotiated rate 25% of the allowable charge
Behavioral Health

Inpatient: 20% of the total charge, plus 20% for separately billed services

Outpatient: 20% of the negotiated rate

Inpatient:

  • High Volume Hospital-25% of the hospital-specific per diem
  • Low Volume Hospital-$218 per day or 25% of the billed charges, whichever is less

Outpatient: 25% of the allowable charge

Home Health Care     $0 $0
Hospice Care $0 $0

Inpatient Services, such as:

  • Hospitalization
  • Skilled Nursing* 

$250 per day or 25% of billed charges, whichever is less, plus 20% for separately billed services.

$744 per day or 25% of billed charges, whichever is less, plus 25% for separately billed services.

Maternity Care

Global fee for office visits & 
hospitalization for delivery 
planned in a hospital: $250 per day or 25% of billed charges, whichever is less, plus 20% for separately billed services

Office visits for delivery planned in a birthing center, home or other setting: 20% of the negotiated rate

Global fee for office visits & 
hospitalization for delivery 
planned in a hospital: $744 per day or 25% of billed charges, whichever is less, plus 25% for separately billed services.

Office visits for delivery planned in a birthing center, home or other setting: 25% of the allowable charge

Newborn Care

The lower of the number of hospital days minus 3 multiplied by $250 or 25% of the negotiated rate, plus 20% for separately billed professional charges.

The lower of the number of hospital days minus 3 multiplied by DRG per diem copayment or 25% of billed charges, plus 25% for separately billed professional charges.

Outpatient Services (which include):  
20% of the negotiated rate 25% of the allowable charge

*Skilled Nursing is only available in the U.S. and U.S. Territories.

**The following Preventive Services are available free of charge: colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6.

Last Updated 4/10/2014