Note: Visit our Copayment and Cost-Share Information page for 2021 costs.
- Tricare Prime Ambulance Copay Card
- Tricare Prime Ambulance Copays
- Tricare Prime Retired Copay
- Tricare Prime Retiree Copay
- Is There A Copay For Tricare Prime
- Tricare Prime Copay Increase
If you have Tri Care Prime then the co=pay for: ER is $ 30.00 and Ambulance is $20.00 I just paid my bill the other day for the ER/Ambulance and Hospital stay was $11.00 per day (7-days @ $77.00 less co-pay $25.00 = $52.00). The TRICARE Prime copay will only be charged to those service members and their families who are not active duty. However, there is a TRICARE Prime cost added if members use the point-of-service option. This happens when members fail to get a referral from their PCM for specialist services. They will, therefore, pay costs out-of-pocket as required.
- Retirees covered under TRICARE Prime will also see minor copay increases. These will apply to emergency room visits, outpatient surgery and ground ambulance. Copays for these items will increase by $1. Also, copays for inpatient admissions will increase by $4 per admission.
- Copayments are per occurrence or per visit. Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services. Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap.
- . PURCHASING TRICARE RESERVE SELECTIf your family members were not enrolled in TRICARE Prime or TOP Prime when you separated from active duty and would like to enroll, you must complete. And submit it to your regional contractor or TOP Regional Call Center. For new enrollments in TRICARE Prime, stateside enrollment.
View the cost information below for retirees and their family members (not including TRICARE Young Adult) with sponsors who enlisted before Jan. 1, 2018.
| TRICARE Prime | TRICARE Select | |
|---|---|---|
| Enrollment Fees | $300/individual, $600/family (annually) | $0 |
| Annual Deductibles | $0 | $150/individual, $300/family |
| Catastrophic Cap | $3,000 per calendar year | $3,000 per calendar year |
Note:Point of Service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries.
Annual deductibles apply to outpatient services only.
| Type of Care | TRICARE Prime | TRICARE Select |
|---|---|---|
| Ambulance Services - Outpatient | $41 | Network Provider: $90 Non-Network Provider: 25% |
| Ambulatory Surgery | $62 | Network Provider: 20% Non-Network Provider: 25% |
| Ancillary Services | $0 | Network Provider: $0 Non-Network Provider: 25% |
| Durable Medical Equipment | 20% | Network Provider: 20% Non-Network Provider: 25% |
| Emergency Room | $62 | Network Provider: $118 Non-Network Provider: 25% |
| Home Health Care | $0* | $0* |
| Hospice Care | $0 | $0 |
| Hospitalization - Physical Health | $156 per admission | Network Provider: Lesser of $250 per day or 25%, plus 20% of professional fees Non-Network Provider: Lesser of $1,035 per day or 25%, plus 25% of professional fees |
| Hospitalization - Mental Health | $156 per admission | Network Provider: Lesser of $250 per day or 25%, plus 20% of professional fees Non-Network Provider: 25% |
| Laboratory and X-Rays | $0 | Network Provider: $0 Non-Network Provider: 25% |
| Maternity Care - Inpatient Delivery Setting | $156 per admission | Network Provider: Lesser of $250 per day or 25%, plus 20% of professional fees Non-Network Provider: Lesser of $1,035 per day or 25%, plus 25% of professional fees |
| Office Visits - Primary Care | $20 | Network Provider: $30 Non-Network Provider: 25% |
| Office Visits - Specialty Care | $31 | Network Provider: $45 Non-Network Provider: 25% |
| Outpatient Mental Health Visits | $31 | Network Provider: $45 Non-Network Provider: 25% |
| Partial Hospitalization | $31 per day** | Network Provider: $45** Non-Network Provider: 25% |
| Preventive Services - Eye Examinations | $0 | Not a covered benefit |
| Preventive Services - All Other Covered Services | $0 | $0 |
| Residential Treatment Center | $31 per day | Network Provider: Lesser of $250 per day or 25%, plus 20% of professional fees Non-Network Provider: 25% of allowable charges |
| Skilled Nursing Facility | $31 per day | Network Provider: Lesser of $250 per day or 25%, plus 20% of professional fees Non-Network Provider: 25% of allowable charges |
| Urgent Care Services | $31 | Network Provider: $30 Non-Network Provider: 25% |
*Costs may apply for durable medical equipment (DME) and medications/drugs.
**Copayment information is calculated per day for partial hospitalization programs and intensive outpatient treatment. Opioid treatment program services copayment is applied on a weekly basis.
Tricare Prime Ambulance Copay Card
- TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.
- TRICARE Young Adult costs are based on the sponsor's status.
- Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost-share information, based on the TRICARE plan type.
A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:
Tricare Prime Ambulance Copays
- Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
- Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.
Tricare Prime Retired Copay
Outpatient costs are applied to the following transports:
Tricare Prime Retiree Copay
- beneficiary's residence, accident scene or other location to a military or VA hospital, or skilled nursing facility (SNF)
- hospital or SNF to the beneficiary's residence
Inpatient costs are applied to the following transports:
- between hospitals or SNFs
- emergency room or civilian hospital to a military or VA hospital
- emergency room to a hospital more capable of providing the required level of care
TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)
| Active Duty Family Members | Retirees and Their Family Members |
|---|---|
Group A: Outpatient: $0 Group B: Outpatient: $0 | Group A: Outpatient: $42 Group B: Outpatient: $42 |
TRICARE Select (not including TRICARE Young Adult)
Is There A Copay For Tricare Prime
| Active Duty Family Members | Retirees and Their Family Members |
|---|---|
Group A: Outpatient: Network Provider: $70 Inpatient: 20% Group B: Outpatient: Network Provider: $15 Inpatient: 20% | Group A: Outpatient: Network Provider: $93 Inpatient: 25% Group B: Outpatient: Network Provider: $63 Inpatient: 25% |
TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)
| TRS | TRR |
|---|---|
Outpatient: Network Provider: $15 Inpatient: 20% | Outpatient: Network Provider: $63 Inpatient: 25% |
TRICARE Young Adult (TYA)
Tricare Prime Copay Increase
| TYA Prime | TYA Select | ||
|---|---|---|---|
| Active Duty Family Members | Retiree Family Members | Active Duty Family Members | Retiree Family Members |
| Outpatient: $0 Inpatient: $0 | Outpatient: $42 Inpatient: 25% | Outpatient: Network Provider: $15 Inpatient: 20% | Outpatient: Network Provider: $63 Inpatient: 25% |