What is cost-sharing in TRICARE?
Quick Answer
TRICARE cost-sharing includes enrollment fees, annual deductibles, copays for visits, and percentage-based cost-shares. Amounts vary by plan type, beneficiary category, and provider network status.
Detailed Answer
Cost-sharing in TRICARE refers to the out-of-pocket expenses that beneficiaries are responsible for when receiving healthcare services. TRICARE cost-sharing has several components: enrollment fees (annual or monthly premiums depending on the plan), annual deductibles (the amount paid before TRICARE begins covering cost-shares, applicable to TRICARE Select), copays (fixed dollar amounts for specific services like office visits or prescriptions), and cost-shares (percentage-based payments where the beneficiary pays a portion of the total allowed charge). Cost-sharing amounts vary based on the beneficiary's category (active duty, active duty family, retiree, or retiree family), the TRICARE plan (Prime, Select, or other), and whether a network or non-network provider is used. Active duty service members have no cost-sharing for any TRICARE-covered services. The annual catastrophic cap limits total out-of-pocket costs per family per fiscal year. Preventive care services have no cost-sharing for most beneficiaries. Understanding cost-sharing helps beneficiaries make informed decisions about their healthcare and choose the plan that best fits their budget and needs.
Related TRICARE Terms
Related Questions
How much does TRICARE cost?
Costs vary by plan and beneficiary status. Active duty members have no costs. Retirees and their families pay enrollment fees and cost-shares.
What is the TRICARE catastrophic cap?
The catastrophic cap is the maximum amount a TRICARE beneficiary family will pay out of pocket for covered services in a fiscal year, after which TRICARE pays 100%.