TRICARE Emergency Room Coverage & 2026 Costs
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## Quick answer TRICARE covers emergency room (ER) visits for all beneficiaries to treat medical or psychiatric emergencies that threaten life, limb, or sight. If you have a true emergency, go to the nearest hospital; you do not need prior authorization, but you must notify your Primary Care Manager (PCM) within 24 hours of admission.
Details
### What Qualifies as an Emergency? TRICARE defines an emergency as a medical condition that would lead a "prudent layperson" to believe that a delay in treatment would result in death, loss of limb or sight, or severe permanent disability. This includes: * Chest pain or signs of a stroke. * Severe bleeding or compound fractures. * Inability to breathe. * Sudden, severe psychiatric distress or risk of self-harm.
### Costs and Copays (2026 Rates) Your out-of-pocket costs depend on your plan and beneficiary status. Note that for **Active Duty Service Members (ADSMs)**, ER care is always $0.
For other beneficiaries (Select, Prime, and Retirees), 2026 costs typically follow these structures (check specific group status for exact figures):
* **TRICARE Prime:** Retirees and their families usually pay a flat copayment per visit (varies by plan year — check TRICARE.mil for current rates). Active Duty Family Members (ADFMs) on Prime typically pay $0. * **TRICARE Select:** Beneficiaries usually pay a flat copayment (for Group A) or a percentage of the allowable charge (for Group B) once their deductible is met. * **TRICARE For Life:** TRICARE acts as a secondary payer to Medicare. If Medicare covers the ER visit, TRICARE typically covers the remaining out-of-pocket cost.
### The "Follow-Up" Rule While the emergency visit itself does not require a referral, any **follow-up care** resulting from that ER visit (such as a specialist consultation or physical therapy) requires a referral from your PCM if you are enrolled in a Prime plan. If you seek follow-up care without a referral, it will be processed under the Point-of-Service (POS) option, resulting in significantly higher out-of-pocket costs.
### Regional Contractors If you are admitted to the hospital from the ER, you or a family member must contact your regional contractor within 24 hours or the next business day: * **East Region:** Humana Military * **West Region:** TriWest Healthcare Alliance (T-5 Contractor) * **Overseas:** International SOS
## Who this affects * **Active Duty Service Members (ADSMs):** Fully covered, but must report the visit to their command and PCM. * **Active Duty Family Members (ADFMs):** Covered on all plans (Prime/Select); costs vary by plan. * **Retirees and Families:** Covered, typically subject to copayments or cost-shares based on 2026 rates. * **Guard/Reserve:** Members on TRICARE Reserve Select (TRS) are covered similarly to Select beneficiaries. * **TRICARE For Life (TFL):** Beneficiaries with both Medicare and TRICARE coverage.
## Sources * **TRICARE.mil:** [Emergency Care Overview](https://www.tricare.mil/CoveredServices/IsItCovered/EmergencyCare) * **Humana Military (East):** [Emergency and Urgent Care Procedures](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (West):** [Provider and Member Portal](https://www.triwest.com) * **Defense Health Agency (DHA):** [TRICARE Costs and Fees](https://www.tricare.mil/Costs)