TRICARE Cost Co-Pay Schedule

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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.

TRICARE Enrollment and Claims Forms

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