What does an emergency room visit cost under TRICARE?
Quick Answer
ER copays are $40-$50 for Prime and cost shares for Select. Copays are waived if you are admitted to the hospital from the ER.
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Key Takeaways
- Prime: $40-$50 copay
- Waived if admitted
- Select: Cost share applies
- Urgent care often cheaper
Detailed Answer
ER costs depend on your plan and situation.
TRICARE Prime
- ER copay: $40-$50
- Waived if admitted
- Same cost any ER
- Network doesn't apply
TRICARE Select
- Deductible applies first
- Cost share: 15-25%
- Network preferred for lower cost
- Emergency anywhere covered
When Copay Waived
- Admitted to hospital
- From ER to inpatient
- Emergency is confirmed
- Life-threatening condition
Additional Costs
- Physician services
- Lab and imaging
- Medications given
- May have separate charges
Avoiding High ER Costs
- Use urgent care when appropriate
- Call nurse advice line first
- Save ER for true emergencies
- Keep records for appeals
Related Questions
What are the TRICARE Prime copays for common services?
TRICARE Prime copays range from $0 for preventive care to $30 for specialty visits. Active duty members have no copays; families have low copays.
How does TRICARE cover emergency room visits?
TRICARE covers emergency room visits for true emergencies regardless of network status. Copays and cost shares apply but are waived if admitted.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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