How much does TRICARE reimburse providers?
Quick Answer
TRICARE reimburses network providers at TRICARE-allowed amounts based on Medicare rates, which may be lower than provider charges.
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Key Takeaways
- Based on Medicare rates
- Network accepts allowed amounts
- Non-network may charge more
- Check costs before service
Detailed Answer
TRICARE sets maximum amounts it will pay for services.
TRICARE-Allowed Amount
- Based on Medicare rates
- Adjusted for geographic area
- Maximum TRICARE pays
- Provider may charge more
Network Providers
- Accept TRICARE-allowed amount
- Cannot bill you the difference
- File claims for you
- Lower costs for you
Non-Network Providers
- May charge above allowed amount
- Balance billing possible
- You may pay difference
- Higher out-of-pocket costs
How Reimbursement Works
- TRICARE calculates allowed amount
- Subtracts your cost share
- Pays provider the remainder
- EOB shows all amounts
If Provider Charges More
- Network: Writes off difference
- Non-network: May bill you
- Emergency protections exist
- Ask about costs upfront
Related TRICARE Terms
Related Questions
What is the difference between network and non-network providers?
Network providers accept TRICARE rates and file claims for you. Non-network providers may charge more, and you may need to file claims yourself.
What is an Explanation of Benefits (EOB)?
An EOB is a statement from TRICARE showing services billed, amounts TRICARE paid, and any amount you owe. It is not a bill.
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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