TRICARE Copayments 2026: Costs, Rates, and Rules

*Disclaimer: TRICARE.com is an independent reference site and is not affiliated with the official TRICARE program or the Department of Defense. For official policy and the most current data, visit TRICARE.mil.*

## Quick answer A copayment is a fixed dollar amount you pay out-of-pocket for a specific medical service, such as $20 for a primary care visit or $40 for a specialist. These amounts vary based on your TRICARE plan, your sponsor’s military status, and whether you are "Group A" or "Group B."

## In detail Copayments are one of two primary ways you share costs with TRICARE (the other being cost-sharing, which is a percentage). Most copayments only apply after you have met your annual deductible, though some plans, like TRICARE Prime, often have $0 copays for active-duty families using network providers.

### The Group A vs. Group B Distinction Your copayment rates are determined largely by when the sponsor entered the military: * **Group A:** Sponsor’s enlistment or appointment date was **before** January 1, 2018. * **Group B:** Sponsor’s enlistment or appointment date was **on or after** January 1, 2018.

### 2026 Sample Copayments (Network Providers) Below are representative rates for 2026. *Note: Rates typically increase slightly each January 1st.*

### Pharmacy Copayments (2026) Pharmacy costs are managed by **Express Scripts** and are standardized regardless of your health plan (except for Active Duty Service Members, who pay $0): * **Military Pharmacy:** $0 (90-day supply). * **Home Delivery (Generics):** $16 (90-day supply). * **Home Delivery (Brand Name):** $43 (90-day supply). * **Retail Network Pharmacy:** $16 (Generic) / $43 (Brand) for a 30-day supply.

### Point-of-Service (POS) Charges If you are on TRICARE Prime and see a provider without a referral (when one is required), you will not pay standard copayments. Instead, you pay **Point-of-Service charges**, which include a much higher deductible and a 50% cost-share of the TRICARE allowable charge.

## Who this applies to * **Active Duty Service Members (ADSMs):** Generally do not pay copayments; their care is fully covered. * **Active Duty Family Members (ADFMs):** Pay $0 copays on Prime (in-network) but have copayments on Select or when using non-network pharmacies. * **Retirees and their Families:** Pay the highest copayments across both Prime and Select plans. * **TRICARE Reserve Select (TRS) / Retired Reserve (TRRR):** These members follow the Group B cost-share and copayment schedules.

Common scenarios

**Scenario 1: The Retired General Practitioner Visit** Retired SMSgt Miller (Group A) is enrolled in TRICARE Select. He visits his network primary care doctor for a sinus infection in 2026. Having already met his annual deductible, he pays a flat **$38 copayment** at the front desk.

**Scenario 2: The Active Duty Spouse Specialist Visit** Sarah, married to an active duty soldier, is enrolled in TRICARE Prime. She is referred to a cardiologist in the Humana Military (East) network. Because she is an ADFM on Prime and has a valid referral, her copayment is **$0**.

**Scenario 3: Filling a Prescription** An Army Reservist (TRS) needs a brand-name blood pressure medication. He goes to a Walgreens (Network Pharmacy). For a 30-day supply, he pays a **$43 copayment** in 2026.

## Related terms * **Cost-Share:** A percentage of the total allowed amount (e.g., 20%) you pay, common in TRICARE Select for out-of-network care. * **Catastrophic Cap:** The maximum amount you will pay out-of-pocket for all covered TRICARE services each calendar year. * **Deductible:** The fixed amount you must pay out-of-pocket each year before TRICARE begins to pay for covered services. * **TRICARE Allowable Charge:** The maximum amount TRICARE will pay for a specific medical service. * **Point-of-Service (POS) Option:** A penalty-style cost structure for Prime users who bypass the referral process.

## Sources * **TRICARE.mil Cost Checker:** https://www.tricare.mil/Costs/Compare * **Defense Health Agency (DHA):** https://health.mil/ * **Express Scripts TRICARE Pharmacy:** https://militaryrx.express-scripts.com/ * **TriWest Healthcare Alliance (West Region):** https://www.triwest.com/