TRICARE ER Costs: 2026 Copays and Coverage Guide | TRICARE.com

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## Quick answer Emergency room (ER) costs depend on your plan and sponsor status. Active duty service members always pay $0, while family members and retirees typically pay a per-visit copayment (ranging from approximately $40 to $250 in 2026) if they are not seen at a military hospital.

Details

### Active Duty Service Members (ADSMs) If you are on active duty, your emergency care costs are **$0** at any hospital (military or civilian). However, you must notify your Primary Care Manager (PCM) or your service’s nurse advice line within 24 hours of being admitted or receiving emergency care to ensure proper authorizations are in place for follow-up care.

### TRICARE Prime (All Regions) For family members and retirees using TRICARE Prime: * **Military Hospital or Clinic:** $0 copay. * **Civilian Emergency Room (Network):** You will likely pay a fixed copay. For 2026, many Prime retirees pay roughly **$170–$185** per emergency room visit. Active duty family members (ADFMs) on Prime typically pay **$0** for emergency services, though it is vital to confirm the facility is in-network.

### TRICARE Select TRICARE Select users are subject to an annual deductible before the plan pays. After the deductible is met: * **Active Duty Family Members (Group A):** Varies by plan year — typically a flat fee per visit (approx. **$100–$120** in 2026). * **Retirees, their families, and others (Group A):** Usually 20% of the TRICARE-allowed amount or a flat fee (approx. **$230–$250** in 2026).

### Group A vs. Group B Your costs are heavily dictated by when the sponsor joined the military: * **Group A:** Sponsor enlisted or was appointed before January 1, 2018. * **Group B:** Sponsor enlisted or was appointed on or after January 1, 2018. Group B generally has higher flat-rate copays but may have different deductible structures.

### Key Rules for ER Visits * **"Life, Limb, or Eyesight":** TRICARE defines an emergency as a medical condition that would lead a "prudent layperson" to believe that a delay in treatment would result in a threat to life, limb, or eyesight. * **Follow-up Care:** While the ER visit itself is covered, follow-up care must be coordinated through your PCM (for Prime users) to avoid Point-of-Service (POS) charges, which are much higher. * **Facility vs. Professional Fees:** On your Explanation of Benefits (EOB), you may see two charges: one for the hospital facility and one for the doctor. Under most TRICARE plans, these are bundled into a single copayment for ER visits.

## Who this affects * **Active Duty Service Members:** Always $0 out-of-pocket. * **Active Duty Family Members:** Costs vary from $0 (Prime) to modest copays (Select). * **Retirees and Family:** Subject to the highest copays and cost-shares. * **National Guard/Reserve:** Includes those on TRICARE Reserve Select (TRS). * **Survivors and Medically Retired:** Costs depend on their specific Prime or Select enrollment.

## Sources 1. **TRICARE.mil** - Emergency Care Overview: https://www.tricare.mil/emergency 2. **TRICARE.mil** - Compare Costs: https://www.tricare.mil/comparecosts 3. **TriWest Healthcare Alliance** (West Region Contractor): https://www.triwest.com 4. **Humana Military** (East Region Contractor): https://www.humanamilitary.com