Allowable Charge

Maximum amount TRICARE will pay for a covered service.

The allowable charge is the maximum amount TRICARE will pay for a covered healthcare service or supply. This amount is determined by TRICARE's fee schedule and varies based on geographic location and type of service.

Understanding allowable charges: • TRICARE sets maximum reimbursement rates for all covered services • Network providers agree to accept the allowable charge as payment in full • Non-network providers may charge up to 15% above the allowable charge • Beneficiaries are responsible for copays/cost-shares based on the allowable amount

Example If a doctor visit has an allowable charge of $100 and your cost-share is 20%, you pay $20. If using a non-network provider who charges $115 (15% above allowable), you pay the $20 cost-share plus the additional $15.

Using network providers ensures you only pay your cost-share with no additional balance billing.