Coronavirus (COVID-19) Update:
Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. |
2021 Group A Group B; Active Duty Family Members (TRICARE Prime and Select) $1,000 per family, per calendar year: $1,058 per family, per calendar year.
Tricare Prime Copay 2021
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. View 2021 copay rates for VA and VA-approved health care. Update on copayments during COVID-19 pandemic We’re canceling and refunding copayments for the following benefits: All medical care received through VA between April 6, 2020, and September 30, 2021. Note: Visit our Copayment and Cost-Share Information page for 2021 costs. View the cost information below for TRICARE Reserve Select (TRS) beneficiaries. The sponsor's enlistment date does not determine costs. TRS members are covered under TRICARE Select. Benefits, cost-shares and deductibles are the same as Group B active duty family members. You must contact your TRICARE regional contractor to set up a monthly allotment withdrawn from your Department of Defense (DoD) pay center, where feasible, for your monthly payments to start on Jan. Don't try to create an allotment directly through your pay 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.
- 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 Cost For Retired Military
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 (this includes physical, occupational | 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 Group B: Network Provider: $15 | Group A: Network Provider: $30 Group B: Network Provider: $26 |
Specialty Care Outpatient (this includes physical, occupational | Group A: Network Provider: $34 Group B: Network Provider: $26 | Group A: Network Provider: $46 Group B: Network Provider: $42 |
TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)
Service | TRS | TRR |
---|---|---|
Primary Care Outpatient Office Visits | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient (this includes physical, occupational | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |
TRICARE Young Adult (TYA)
Service | TYA Prime | TYA Select | ||
---|---|---|---|---|
Active Duty Family Members | Retiree Family Members | Active Duty Family Members | Retiree Family Members | |
Primary Care Outpatient Office Visits | $0 | $21 | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient Office Visits (this includes physical, | $0 | $31 | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |
The catastrophic cap is the maximum out-of-pocket amount the beneficiary will pay each calendar year for TRICARE-covered services. The beneficiary is not responsible for any amounts over the catastrophic cap in a given year, except for:
- Services that are not covered.
- Point of Service charges.
- The additional 15 percent non-participating providers may charge above the TRICARE allowable charge.
If the beneficiary changes programs during the calendar year under the same sponsor, any amount credited toward the catastrophic cap will roll over to the new program (does not apply to Continued Health Care Benefit Program [CHCBP]).
Tricare For Life Cost 2021
A beneficiary's catastrophic cap is determined by the sponsor's initial enlistment or appointment date:
- Group A: Sponsor's enlistement or appointment date is before Jan. 1, 2018.
- Group B: Sponsor's enlistement or appointment date is on or after Jan. 1, 2018.
Tricare Select Copay 2021
Out-of-pocket expenses that apply towards cap | Out-of-pocket expenses that do NOT apply towards cap |
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2021 Catastrophic Cap Amounts
2021 | Group A | Group B |
---|---|---|
Active Duty Family Members (TRICARE Prime and Select) | $1,000 per family, per calendar year | $1,058 per family, per calendar year |
Retirees and Their Family Members (TRICARE Prime) | $3,000 per family, per calendar year | $3,703 per family, per calendar year |
Retirees and Their Family Members (TRICARE Select) | $3,500 per family, per calendar year | $3,703 per family, per calendar year |
TRICARE Reserve Select (TRS) | $1,058 per family, per calendar year | |
TRICARE Retired Reserve (TRR) | $3,703 per family, per calendar year | |
TRICARE Young Adult (TYA) | Active Duty Family Members:$1,058 per individual, per calendar year Retiree Family Members: $3,703 per individual, per calendar year |
2020 Catastrophic Cap Amounts
2020 | Group A | Group B |
---|---|---|
Active Duty Family Members (TRICARE Prime and Select) | $1,000 per family, per calendar year | $1,044 per family, per calendar year |
Retirees and Their Family Members (TRICARE Prime and Select) | $3,000 per family, per calendar year | $3,655 per family, per calendar year |
TRICARE Reserve Select (TRS) | $1,044 per family, per calendar year | |
TRICARE Retired Reserve (TRR) | $3,655 per family, per calendar year | |
TRICARE Young Adult (TYA) | Active Duty Family Members:$1,044 per individual, per calendar year Retiree Family Members: $3,655 per individual, per calendar year |