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How does TRICARE cover emergency room visits?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini)
Quick Answer
TRICARE covers emergency room visits for true emergencies regardless of network status. Copays and cost shares apply but are waived if admitted.
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Key Takeaways
- True emergencies always covered
- Any ER, any location
- Copay waived if admitted
- Notify TRICARE after visit
Detailed Answer
Emergency care is covered when a true emergency exists.
What Counts as Emergency
- Life-threatening conditions
- Severe pain
- Risk of permanent damage
- Symptoms requiring immediate attention
- Reasonable person would seek ER care
Coverage Details
- Any ER covered for emergencies
- Network status doesn't matter
- No prior authorization needed
- Follow-up care may need authorization
Costs
- Prime: $40-$50 copay
- Select: Cost share applies
- Waived if admitted to hospital
- Counts toward catastrophic cap
After the ER
- Notify TRICARE within 24 hours
- Get authorization for follow-up
- Transfer to network if possible
- Keep all documentation
Non-Emergency ER Use
- Higher costs apply
- May not be covered
- Use urgent care instead
- Contact nurse advice line first
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 urgent care visits?
TRICARE covers urgent care for non-emergency situations needing same-day care. Network urgent care centers are preferred with lower copays.
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