Tricare Standard Copay

Posted : admin On 1/29/2022
  1. Tricare Cost Share 2021

Annual deductibles apply to network and non-network providers for outpatient services only.

  • Deductibles must be met before TRICARE benefits are payable.
  • Once the deductible is met, cost-shares apply.
  • Network providers can collect at a minimum the copayment at the time of service. A provider may also collect the outstanding balance of the deductible. The explanation of benefits (EOB) will inform the beneficiary and provider of the allowed amount and patient responsibility.
  • Deductibles apply to the catastrophic cap.
  • TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve deductibles do not apply to preventive services.
    • Exception: Deductibles will apply to routine eye examinations (when covered), school physicals and assignment-ordered physicals, when performed by non-network providers.

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

  • 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.
  • 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.

If you wish to reinstate your TRICARE Select Group A coverage, you must now call us before June 30 at (800) 444-5445. Continued Health Care Benefit Program (CHCBP) CHCBP is a premium-based plan that offers temporary transitional health coverage for 18 to 36 months after TRICARE eligibility ends. It acts as a bridge between military. Tricare Select is a fee-for-service insurance plan that lets you see any doctor. This plan is available to family members, veterans, and retirees.

  • 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)

Active Duty Family MembersRetirees and Their Family Members

Group A: $0

Group B: $0

Point of Service deductibles are calculated separately.

Group A: $0

Group B: $0

Point of Service deductibles are calculated separately.

Tricare

TRICARE Select (not including TRICARE Young Adult)

Active Duty Family MembersRetirees and Their Family Members

Group A:
E4 and Below: $50/individual, $100/family
E5 and Above: $150/individual, $300/family

Group B:

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

Group A:
$150/individual, $300/family

Group B:

2020: Network Providers: $156/individual, $313/family
Non-Network Providers: $313/individual, $626/family

2021: Network Providers: $158/individual, $317/family
Non-Network Providers: $317/individual, $634/family

TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)

Tricare standard copay for physical therapy
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

2020: Network Providers: $156/individual, $313/family
Non-Network Providers: $313/individual, $626/family

2021: Network Providers: $158/individual, $317/family
Non-Network Providers: $317/individual, $634/family

TRICARE Young Adult

Tricare

The TRICARE Young Adult deductible is based on the sponsor's status.

TRICARE PrimeTRICARE Select
Active Duty
Family Members
Retiree Family
Members
Active Duty Family MembersRetiree Family Members
$0$0

2020:
E4 and Below: $52/individual
E5 and Above: $156/individual

2021:
E4 and Below: $52/individual
E5 and Above: $158/individual

2020:
Network Providers: $156/individual
Non-Network Providers: $313/individual

2021:
Network Providers: $158/individual
Non-Network Providers: $317/individual

Covered Services

Learn more about what we cover -
including health, dental, and pharmacy.

Urgent care is care you need for a non-emergency illness or injury. You need urgent care treatment within 24 hours, and you shouldn't have to travel more than 30 minutes for the care. You typically need urgent care to treat a condition that:

  • Doesn’t threaten life, limb or eyesight.
  • Needs attention before it becomes a serious risk to health.

Examples may include things like a high fever or sprained ankle.

Nurse Advice Line

If it's after hours or you're not sure if you need to see a doctor, call TRICARE's Nurse Advice Line 24/7. Call 1-800-TRICARE (874-2273) — Option 1 to talk to a registered nurse who can:

  • Answer your urgent care questions
  • Give you health care advice
  • Help you find a doctor
  • Schedule next-day appointments at military hospitals and clinics

The Nurse Advice Line is available to all TRICARE beneficiaries in the U.S. except those enrolled in the US Family Health Plan. Beneficiaries who live overseas can call the Nurse Advice Line for health care advice when traveling in the U.S., but must coordinate care with their Overseas Regional Call Center.

TRICARE Prime PlansTRICARE Prime plans include: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas and TRICARE Young Adult-Prime

If you are a(n)…

To get Urgent Care…

Active Duty Family Member

You don’t need a referral.
You can get urgent care from any TRICARE authorized urgent care center or network provider1

Retiree or Retiree Family Member

Active Duty Service Member Enrolled in TRICARE Prime Remote

Active Duty Service Member Living in a TRICARE Prime Service Area1

You should seek care at a military hospital or clinic when/where available, or contact the Nurse Advice Line for assistance.

1If you are a family member or retiree and seek urgent care from a non-network provider outside of a TRICARE authorized urgent care center, you will have to pay point-of-service option cost-shares.

TRICARE Select and All Other TRICARE Plans

Tricare standard copay amount

If you are a(n)…

To get Urgent Care…

Active Duty Family Member

You don’t need a referral.
You can get urgent care from any TRICARE authorized urgent care center or provider.3

Retiree or their Family Member

3You will pay network or non-network copayments or cost-shares, depending on the type of provider you see.

US Family Health Plan

If you are a…

To get Urgent Care…

US Family Health Plan Member

Visit your designated provider’s web site for details

Urgent Care Overseas

If you are…

Seeking care…

To get Urgent Care…

Enrolled in TRICARE plan stateside

Overseas while traveling

You don’t need a referral.

To ensure your urgent care visit is cashless and claimless, you must get prior authorization from the TRICARE overseas contractor. Otherwise, you may have to pay the provider up front and file a claim for reimbursement later.

Enrolled in a TRICARE Overseas plan

Overseas

Stateside while traveling

You don’t need a referral.
You can get urgent care from any TRICARE authorized urgent care center or network provider.4, 5

4If you are enrolled in a TRICARE Prime plan and seek urgent care from a non-network provider outside of a TRICARE authorized urgent care center, you will have to pay point-of-service option cost-shares.

5Active Duty Service Members must follow up with their PCM when they receive care outside of a military hospital or clinic, in accordance with DoD and Service regulations.

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 6/18/2020

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Tricare Cost Share 2021

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Mental Health Therapeutic Services