Tricare Copay 2021

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Tricare copay 2021

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.

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 You must contact your TRICARE regional contractor to set up a monthly allotment withdrawn from your Department of Defense (DoD) pay center, where feasible, for your monthly payments to start on Jan.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.

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 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)

Tricare select copay 2021
ServiceActive Duty Family MembersRetirees 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)

ServiceActive Duty Family MembersRetirees 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%

Tricare

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

ServiceTRSTRR
Primary Care Outpatient
Office Visits		Network Provider: $15
Non-Network Provider: 20%		Network Provider: $26
Non-Network Provider: 25%

Specialty Care Outpatient
Office Visits

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

Network Provider: $26
Non-Network Provider: 20%		Network Provider: $42
Non-Network Provider: 25%

TRICARE Young Adult (TYA)

Tricare Copay 2021
ServiceTYA PrimeTYA Select
Active Duty Family MembersRetiree Family MembersActive Duty Family MembersRetiree Family Members
Primary Care Outpatient Office Visits$0$21Network Provider: $15
Non-Network Provider: 20%		Network Provider: $26
Non-Network Provider: 25%

Specialty Care Outpatient Office Visits

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

$0$31Network 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 capOut-of-pocket expenses that do NOT apply towards cap
  • out-of-pocket deductibles
  • inpatient copayments or cost-shares
  • outpatient copayments or cost-shares
  • pharmacy medication costs
  • enrollment fees under TRICARE Prime and TRICARE Select plans
  • TRICARE Prime Point of Service deductible and cost-share amounts
  • payments for non-covered services
  • premiums paid under TRICARE Reserve Select, TRICARE Retired Reserve and TRICARE Young Adult

2021 Catastrophic Cap Amounts

2021Group AGroup 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

2020Group AGroup 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