Chart does not include using non-network retail pharmacies and represents the TRICARE copayments effective as of January 1, 2019. Using Home Delivery with Other Health Insurance (OHI) In addition to TRICARE, many beneficiaries have additional insurance coverage, often through their employer, Medicare Part D, or another private insurance program. This page contains the link to the Benefits A-Z area which explains what is covered, excluded or has limitations.as well as important cost information. TRS members are covered under TRICARE Select. Benefits, cost-shares and deductibles are the same as Group B active duty family members. Enrollment Fees. $44.17/individual, $228.27/family. (monthly) Annual Deductibles. E-4 and Below: $52/individual, $104/family. E-5 and Above: $156/individual, $313/family. Catastrophic Cap. 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). The TRICARE Pharmacy Program, administered by Express Scripts, is designed to provide the medications beneficiaries need, when they need them, in a safe, convenient and cost-effective manner.
- Copayments and cost-shares are subject to change at the beginning of each calendar year.
- 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.
- Point of Service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries (excluding active duty service members).
Important Note: Active duty service members do not have any out-of-pocket costs for care.
2021 Costs
Active Duty Family Members | Retirees and Their Family Members | TRICARE Reserve Select (TRS) | TRICARE Retired Reserve (TRR) | TRICARE Young Adult (TYA) |
---|---|---|---|---|
Enlisted before 01/01/18 | Enlisted before 01/01/18 | All | All | All |
Enlisted on or after 01/01/18 | Enlisted on or after 01/01/18 |
Tricare Copays Pdf
2021 Cost Information by Benefit
Detailed information on copayments and cost-shares is listed below by benefit. You can also view this information using the cost links in our Benefits A-Z list.
Pharmacy
Tricare Copay Urgent Care
Mental Health
Tricare Copays And Deductibles
Active Duty Family Members | Retirees and Their Family Members | TRICARE Reserve Select (TRS) | TRICARE Retired Reserve (TRR) | TRICARE Young Adult (TYA) |
---|---|---|---|---|
Enlisted before 01/01/18 | Enlisted before 01/01/18 | All | All | All |
Enlisted on or after 01/01/18 | Enlisted on or after 01/01/18 |