TRICARE Emergency Room Costs: 2026 Rates & Rules
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## Quick answer Active duty service members (ADSMs) have $0 out-of-pocket costs for emergency room visits at any hospital. For all other beneficiaries, costs depend on your plan type and sponsor status, typically ranging from a small copayment (e.g., $40–$100) to 20% of the allowed cost if the deductible hasn't been met.
Details
Emergency care is defined by TRICARE as medical services for a condition that a "prudent layperson" would consider a threat to life, limb, sight, or cause undue suffering. You do not need a referral for emergency care, but you must notify your Primary Care Manager (PCM) within 24 hours of admission.
Costs by Plan Category (2026 Rates)
Costs are generally split between "Group A" (sponsor entered service before Jan. 1, 2018) and "Group B" (sponsor entered service on or after Jan. 1, 2018).
* **Active Duty Service Members:** $0 at all facilities. * **Active Duty Family Members (ADFMs):** * **TRICARE Prime:** $0 copayment. * **TRICARE Select:** Varies by group. For 2026, many Group A ADFMs pay a flat copayment (approx. $100–$120), while Group B may pay a percentage after the deductible. * **Retirees and their Families:** * **TRICARE Prime:** A fixed copayment (typically around $180–$200 for 2026). * **TRICARE Select:** Typically a percentage of the TRICARE-allowed amount (20–25%) after the annual deductible is met. * **TRICARE Reserve Select (TRS) & TRICARE Retired Reserve (TRR):** These members follow the TRICARE Select cost-sharing structure, usually paying a percentage of the cost after the deductible.
### Facility Types: Military vs. Civilian If you go to a **Military Hospital or Clinic**, there is $0 cost for all beneficiary types. However, space is often limited, and civilian ERs are used for most true emergencies. If you use a **Civilian Hospital**, ensure they are TRICARE-authorized to avoid balance billing (the hospital charging you the difference between their rate and TRICARE's payment).
### The "Observation" Trap If the ER holds you for "observation" rather than admitting you as an inpatient, you are still charged the emergency room rate. If you are admitted to the hospital, the ER copayment is usually waived, and you instead pay the inpatient cost-share assigned to your plan.
### Follow-up Care While the ER visit itself does not require a referral, any follow-up care (specialists, physical therapy, etc.) resulting from that ER visit **does** require a referral for Prime members.
## Who this affects * **Active Duty Service Members:** Always covered at 100%. * **Active Duty Families:** On Prime (no cost) or Select (copays apply). * **Retirees & Families:** Copays or cost-shares always apply in civilian facilities. * **National Guard & Reserve:** TRS/TRR members subject to deductibles and cost-shares. * **TRICARE For Life (TFL):** TRICARE acts as a secondary payer to Medicare; usually results in $0 for the ER visit if Medicare covers the service.
## Sources 1. **TRICARE.mil Emergency Care Overview:** https://www.tricare.mil/CoveredServices/IsItCovered/EmergencyCare 2. **TRICARE Cost Comparison Tool:** https://www.tricare.mil/Costs/Compare 3. **TriWest Healthcare Alliance (West Region):** https://www.triwest.com 4. **Humana Military (East Region):** https://www.humanamilitary.com