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Costs

Find your TRICARE costs, including copays,
enrollment fees, and payment options.

Cost Terms

Here are some definitions to help you better understand your costs with TRICARE.

Term Definition Plans where you will find it Additional Information
Allowable chargeClick to closeThe maximum amount TRICARE pays for each procedure or service.  This is tied by law to Medicare's allowable charges. The maximum amount TRICARE will pay a doctor or other provider for a procedure, service, or equipment. Non-participating providers can charge you up to 15% more than the allowable charge that TRICARE will pay. If you use a non-participating provider, you will have to pay all of that additional charge up to 15%. All TRICARE plans TRICARE sets CHAMPUS Maximum Allowable Rate (CMAC) for most services. Many rates vary based on location, since health care costs more in some places and less in others. In some cases, federal law requires a set rate. You can find more info at www.health.mil/rates.
Annual deductible The amount you must pay before cost-sharing begins.

TRICARE Select

TRICARE Select Overseas

TRICARE Reserve Select

TRICARE Retired Reserve

TRICARE Young Adult-Select option

TRICARE For Life (for services not covered by Medicare and TRICARE)

If you have a TRICARE Prime plan, you have to meet your annual deductible when using the point-of-service option.
When you meet your individual deductible, TRICARE cost-sharing will begin.
Catastrophic cap The most you pay out of pocket annually for TRICARE-covered services. All TRICARE plans

The catastrophic cap applies to all covered services, including yearly deductibles, pharmacy Copayments, and other cost-shares based on TRICARE-allowable charges.

The catastrophic cap does not apply to Point-of-Service fees or enrollment fees for TRICARE Prime and TRICARE Select.
CopaymentClick to closeA fixed dollar amount you may pay for a covered health care service or drug. The fixed dollar amount you pay for a covered health care service or drug.

TRICARE Prime and TRICARE Prime Remote (Does not apply to Active Duty service members)

TRICARE Select for services received from network providers.

A Copayment for an appointment also covers your costs for tests and other ancillary services you get as part of that appointment. So if your doctor runs blood work as part of your visit, or you have an EKG or other test covered by TRICARE, you will normally not have a separate Copayment for those tests.
Cost-share The percentage of the total cost of a covered health care service that you pay.

All TRICARE Plans

(Does not apply to Active Duty service members)

If you see several doctors as part of an appointment, or have additional tests, you may have more than one cost-share. For instance, if you have a surgery, you may have separate cost-shares for the facility, the surgeon, and the anesthesiologist.
Negotiated rate The contractors who manage care in the civilian network try to save you and the government money by making agreements with providers to accept less than the allowable charge for your care.

All TRICARE Plans

(Does not apply to Active Duty service members)

Since some plans have cost-shares that are a percentage of the charge, a lower rate helps keep your costs down. That’s why it is usually less expensive for you to use a network provider for your care.
Point-of-service fees

The fees you pay when you see a TRICARE-authorized providerClick to closeAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. other than your primary care manager for any nonemergency services without a referral.

 

The costs are higher when you don’t follow referral requirements or use non-network providers without authorization from the TRICARE regional contractor.

TRICARE Prime

(Does not apply to Active Duty service members)
You pay an annual deductible before TRICARE cost-sharing begins. The deductibles are $300 per individual/$600 per family. For services beyond this deductible, you pay 50% of the TRICARE-allowable charge. These costs do not apply to your catastrophic cap.
Travel expensesClick to closeAmounts you pay when traveling to and from your appointment.  This includes costs for gas, meals, tolls, parking, lodging, local transportation, and tickets for public transportation. The amount you pay when traveling to and from your appointment. This includes costs for gas, meals, tolls, parking, lodging, local transportation, and tickets for public transportation.

TRICARE Prime

TRICARE Prime Remote

TRICARE For Life

Prime Travel Benefit
In some instances, TRICARE may reimburse your travel expenses for care.

To receive reimbursement for travel expenses for specialty care:

  • You can’t be on active duty.
  • You must have a referral from your primary care manager (PCM).
  • The specialty provider's office must be more than 100 miles from your PCM's office.

If all three apply to you, you may qualify for the Prime Travel Benefit.

TRICARE diagnostic-related group (DRG) A payment system that determines the allowable amount. TRICARE Select >>Learn more


Last Updated 12/6/2018