What is cost-sharing in TRICARE?

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.