TIP:
Saving your receipts can save you both money and headaches. Some health care expenses can be deducted from your taxes, and you never know when you may be incorrectly double billed.
Saving your receipts can save you both money and headaches. Some health care expenses can be deducted from your taxes, and you never know when you may be incorrectly double billed.
The following tables provide examples of cost-shares or copayments and annual deductibles for families who use civilian providers and facilities under each of the three TRICARE options.
The listed fees are subject to change each year. Contact your local Health Benefits Advisor (HBAs) - located at your local Military Treatment Facilities (MTFs) - or beneficiary counseling and assistance coordinator (BCAC) for answers to any questions about coverage, co-payments and cost shares.
Cost shares and deductibles for Active Duty, Guard and Reserve Family Members:
|
TRICARE Prime |
TRICARE Extra |
TRICARE Standard | |
|
Annual Deductible |
None |
$150/individual or $300/family for E-5 & above; $50/$100 for E-4 & below |
$150/individual or $300/family for E-5 & above; $50/$100 for E-4 & below |
|
Annual Enrollment Fee |
None |
None |
None |
|
Civilian Outpatient Visit |
No cost |
15% of negotiated fee |
20% of allowed charges for covered service |
|
Civilian Inpatient Admission |
No cost |
Greater of $25/Charge per admission or $15.65/day |
Greater of $25/Charge per admission or $15.65/day |
|
Civilian Inpatient Mental Health |
No cost |
Greater of $25/Charge per admission or $20.00/day |
Greater of $25/Charge per admission or $20.00/day |
|
Civilian Inpatient Skilled Nursing Facility Care |
$0 per diem charge per admission No separate co-payment/cost-share for separately billed professional charges |
Greater of $25/Charge per admission or $15.65/day |
Greater of $25/Charge per admission or $15.65/day |
Cost Shares for Retirees (under 65), Their Family Members, and Others:
|
TRICARE Prime |
TRICARE Extra |
TRICARE Standard | |
|
Annual Deductible |
None |
$150/individual or $300/family |
$150/individual or $300/family |
|
Annual Enrollment Fee |
$230/individual $460/family |
None |
None |
|
Civilian Co-pays |
|
20% of negotiated fee |
25% of allowed charges for covered service |
|
Outpatient Emergency Care Mental Health Visit |
$12 $30 $25 $17 (group visit) |
20% of negotiated fee |
25% of allowed charges for covered service |
|
Civilian Inpatient Cost Share |
$11/day ($25 minimum) Charge per admission |
Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated professional fees |
Lesser of $535/day or 25% of billed charges plus 25% of allowed professional fees |
|
Civilian Inpatient Skilled Nursing Facility Care |
$11/day ($25 minimum) charge per admission |
$250 per diem co-payment or 20% cost-share of total charges, whichever is less, institutional services, plus 20% cost-share of separately billed professional charges |
25% cost-share of allowed charges for institutional services, plus 25% cost-share of allowable for separately billed professional charges. |
|
Civilian Inpatient Mental Health |
$11/day, ($25 Minimum) |
20% of institutional & negotiated professional fees |
Lesser of $193/day or 25% of allowable fees |
For general information about TRICARE, call the toll-free TRICARE information line for your region found at the TRICARE Contact Us web page.
