Medical Service Copays
What you pay for common medical services by plan type:
| Service | AD Prime | Family Prime | Select (Network) |
|---|---|---|---|
| Primary Care Visit | $0 | $0 | $30 |
| Specialist Visit | $0 | $0 | $40 |
| Urgent Care | $0 | $30 | $40 |
| Emergency Room | $0 | $65 | $65 |
| Outpatient Mental Health | $0 | $0 | $30 |
| Inpatient Hospital (per day) | $0 | $0 | $175/day ($25 min) |
| Maternity / Delivery | $0 | $0 | $175/day |
| Preventive Care | $0 | $0 | $0 |
| Labs & X-rays | $0 | $0 | $28 |
Non-network TRICARE Select typically costs 25% of allowed charges plus any amount above the TRICARE allowable charge. Always use network providers when possible.
Prescription Copays
| Pharmacy / Type | Copay |
|---|---|
| Generic (MTF) | $0 |
| Generic (Mail Order) | $0 |
| Generic (Retail) | $14 |
| Brand (Mail Order) | $29 |
| Brand (Retail) | $38 |
| Non-Formulary (Mail) | $65 |
| Non-Formulary (Retail) | $68 |
Annual Limits & Caps
| Item | Amount |
|---|---|
| Annual Deductible (Prime) | $0 |
| Annual Deductible (Select, Individual) | $150 / $300 family (E-5+) |
| Annual Deductible (Select, E-1 to E-4) | $50 / $100 family |
| Catastrophic Cap (Active Duty Family) | $1,000/year |
| Catastrophic Cap (Retiree Family) | $3,500/year |
| Catastrophic Cap (Reserve) | $3,500/year |
Good news: Once you hit the catastrophic cap, TRICARE covers 100% of all covered services for the rest of the year.
Common Questions
What's the difference between a copay and a cost share?
A copay is a fixed dollar amount you pay (like $30 for a doctor visit). A cost share is a percentage of the total cost (like 25% of allowed charges). TRICARE Prime mostly uses copays. TRICARE Select uses both copays (network) and cost shares (non-network).
What is the catastrophic cap?
The catastrophic cap is the most you'll pay out of pocket in a year. Once you hit this limit, TRICARE covers 100% of covered services for the rest of the calendar year. Active duty families cap at $1,000; retirees cap at $3,500.
Do active duty service members pay anything?
Active duty members pay $0 for all covered medical care. Their family members on TRICARE Prime also pay $0 for most services. Family members on TRICARE Select have copays and cost shares.
Is preventive care really free?
Yes. Preventive care — including annual physicals, well-child visits, immunizations, and recommended cancer screenings — is covered at $0 copay for all TRICARE beneficiaries regardless of plan type.