Coinsurance

Coinsurance is the percentage of the cost of a covered healthcare service that you pay after you have met your annual deductible. In TRICARE, coinsurance and cost-share are often used interchangeably, though technically coinsurance refers specifically to the percentage-based payment model.

How coinsurance works in TRICARE: • After meeting your annual deductible, you pay a percentage of each covered service • TRICARE pays the remaining percentage of the allowable charge • The percentage you pay varies by plan, beneficiary category, and provider type

Typical coinsurance rates: • TRICARE Select (Active Duty Family Members): 15% network, 20% non-network • TRICARE Select (Retirees): 20% network, 25% non-network • TRICARE Prime: Uses copayments rather than coinsurance for most services

Coinsurance payments count toward your annual catastrophic cap, which limits your total out-of-pocket spending in a fiscal year. Once you reach the catastrophic cap, TRICARE covers 100% of allowable charges for the remainder of the year.