Copayment
Quick Definition
Fixed amount you pay for covered services.
Video Explanation
Full Definition
A copayment (or copay) is a fixed dollar amount you pay for covered healthcare services at the time of service. The amount varies based on your TRICARE plan, the type of service, and your beneficiary category.
Common copayment examples: • TRICARE Prime civilian provider visit: $0-$34 (varies by rank/status) • TRICARE Select civilian provider visit: Greater of $31 or 27% of negotiated fee • Emergency room visit: $104 (TRICARE Prime), varies (TRICARE Select) • Urgent care: $34 (TRICARE Prime), varies (TRICARE Select)
Copays vs. Cost-shares: • Copays: Fixed dollar amounts (e.g., $31 per visit) • Cost-shares: Percentage of allowable charge (e.g., 20% of the bill)
Active duty service members never pay copays for any care. Active duty family members have lower copays than retirees and their families.
All copays count toward your annual catastrophic cap, providing financial protection against high healthcare costs. Military Treatment Facilities typically don't charge copays for most services.
Related Questions
What is the difference between TRICARE Prime and TRICARE Select?
TRICARE Prime is a managed care option with a primary care manager and lower costs. TRICARE Select offers more flexibility to choose providers with higher out-of-pocket expenses.
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 TRICARE For Life and who qualifies?
TRICARE For Life is Medicare wraparound coverage for TRICARE-eligible beneficiaries age 65+ who have Medicare Parts A and B.
Does TRICARE cover prescriptions?
Yes, TRICARE covers most prescriptions through military pharmacies, network pharmacies, and home delivery.
Does TRICARE cover mental health services?
Yes, TRICARE covers mental health services including therapy, counseling, and psychiatric care with the same cost-shares as medical services.
How does TRICARE cover emergency room visits and urgent care?
TRICARE covers emergency care worldwide without prior authorization. Visit nearest ER for emergencies; urgent care for non-emergencies.
How does the TRICARE catastrophic cap work?
The catastrophic cap is your maximum annual out-of-pocket cost. Once reached, TRICARE pays 100% of covered services for the rest of the fiscal year.
How much do prescriptions cost with TRICARE?
Prescription costs vary by location: military pharmacies are free, network pharmacies charge $13-$60 copays, and home delivery offers lower costs for 90-day supplies.
Related Terms
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