How does TRICARE cover emergency room visits?
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.
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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