Bread Crumbs

Cost Shares for Retired Service Members, Their Families and 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.

These costs are effective 10/1/2014.
Service Cost
Ambulance Services In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Ambulatory Surgery (Same Day) In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Behavioral Health (Inpatient) In-Network:
20% of the total charge plus 20% for separately billed services

Out-of-Network:
High-volume Hospitals:
25% hospital specific per diem, plus 25% for separately billed services

Low-volume Hospitals:
$224 per day or 25% of the billed charges, whichever is less, plus 25% for separately billed services

Residential Treatment Center:
25% of the allowed amount

Partial Hospitalization:
25% of the allowed amount, plus 25% of the allowable charge for separately billed professional services
Behavioral Health (Outpatient) In-Network: 20% of negotiated fee / Out-of-Network: 25% 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.

In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
DME, Prosthetic Devices, Medical Supplies In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Emergency Services In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care) In-Network:
$250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Out-of-Network:
$764 per day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges
Immunizations $0
Laboratory & X-ray In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting) In-Network:
$250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Note: This is one global fee for all of the maternity care and delivery.

Out-of-Network:
$764 per day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges

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) In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Maternity (office visits for delivery planned at home or other setting) In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Newborn Care In-Network:
The lower of the number of hospital days minus 3 multiplied by $250 or 25% of the negotiated rate for institutional services, plus 20% for separately billed professional charges

Out-of-Network:
The lower of the number of hospital days minus 3 multiplied by $764 or 25% of billed charges for institutional services, plus 25% for separately billed professional charges.
Outpatient Visit In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Skilled Nursing (Inpatient) In-Network:
$250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Out-of-Network:
25% for institutional services, plus 25% cost share for separately billed professional charges

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