Tricare Prime Retiree Copay

Posted : admin On 1/29/2022

TRICARE Reserve Select (TRS) TRICARE Retired Reserve (TRR) 2020: E4 and Below: $52/individual, $104/family E5 and Above: $156/individual, $313/family. 2021: E4 and Below: $52/individual, $105/family E5 and Above: $158/individual, $317/family. When leaving active duty, Service members may be entitled to or eligible for benefits offered by TRICARE and Department of Veterans Affairs (VA), depending on whether the Service member retires or separates. If retiring, the Service member is eligible for TRICARE as a military retiree and may also be eligible for certain VA benefits. TRICARE Prime Out-of-Pocket Costs ADSMs, ADFMs, and transitional survivors Covered service Group A Group B All covered services $0 $0 Retirees, their families, and all others Covered service Group A Group B Preventive Care Visit $0 $0 Primary Care Outpatient Visit $21 $21 Specialty Care Outpatient Visit $31 $31 Urgent Care Center Visit $31 $31. TRICARE Prime and TRICARE Young Adult Prime retirees have a separate copayment for allergy shots performed on a different day than the office visit, or performed by a different provider, such as an independent laboratory or radiology facility (even if performed on the same day as the related office visit). Note: Visit our Copayment and Cost-Share Information page to view 2020 costs. Ambulatory surgery costs apply to same day surgery in an outpatient hospital setting or ambulatory surgery center. 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.

Coronavirus (COVID-19) Update:

Testing copayment waiver: Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for medically necessary COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits during which tests are ordered or administered. COVID-19 diagnostic and antibody tests must meet Families First Coronavirus Response Act (FFCRA) criteria in order to be eligible for the cost-share and copayment waivers.
Telemedicine copayment waiver: TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayment or cost-share. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees.

Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate.

Note: Visit our Copayment and Cost-Share Information page to view 2020 costs.

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.
TRICARE Prime and TRICARE Young Adult Prime retirees have a separate copayment for allergy shots performed on a different day than the office visit, or performed by a different provider, such as an independent laboratory or radiology facility (even if performed on the same day as the related office visit).
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.

Tricare Prime Co Pay

A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:

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 and TRICARE Prime Remote (not including TRICARE Young Adult)

Service	Active Duty Family Members	Retirees and Their Family Members
Primary Care Outpatient Office Visits	Group A: $0 Group B: $0	Group A: $21 Group B: $21
Specialty Care Outpatient Office Visits (this includes physical, occupational and speech therapy, and provisional coverage benefits)	Group A: $0 Group B: $0	Group A: $31 Group B: $31

Service

Active Duty Family Members

Retirees and Their Family Members

Primary Care Outpatient
Office Visits

Group A: $0

Group B: $0

Group A: $21

Group B: $21

Specialty Care Outpatient
Office Visits

(this includes physical, occupational
and speech therapy, and provisional coverage benefits)

Group A: $0

Group B: $0

Group A: $31

Group B: $31

TRICARE Select (not including TRICARE Young Adult)

Service	Active Duty Family Members	Retirees and Their Family Members
Primary Care Outpatient Office Visits	Group A: Network Provider: $22 Non-Network Provider: 20% Group B: Network Provider: $15 Non-Network Provider: 20%	Group A: Network Provider: $30 Non-Network Provider: 25% Group B: Network Provider: $26 Non-Network Provider: 25%
Specialty Care Outpatient Office Visits (this includes physical, occupational and speech therapy, and provisional coverage benefits)	Group A: Network Provider: $34 Non-Network Provider: 20% Group B: Network Provider: $26 Non-Network Provider: 20%	Group A: Network Provider: $46 Non-Network Provider: 25% Group B: Network Provider: $42 Non-Network Provider: 25%

Service

Active Duty Family Members

Retirees and Their Family Members

Primary Care Outpatient
Office Visits

Group A:

Network Provider: $22
Non-Network Provider: 20%

Group B:

Network Provider: $15
Non-Network Provider: 20%

Group A:

Network Provider: $30
Non-Network Provider: 25%

Group B:

Network Provider: $26
Non-Network Provider: 25%

Specialty Care Outpatient
Office Visits

(this includes physical, occupational
and speech therapy, and provisional coverage benefits)

Group A:

Network Provider: $34
Non-Network Provider: 20%

Group B:

Network Provider: $26
Non-Network Provider: 20%

Group A:

Network Provider: $46
Non-Network Provider: 25%

Group B:

Network Provider: $42
Non-Network Provider: 25%