Cost-Share
Quick Definition
Percentage of costs you pay for covered services.
Video Explanation
Full Definition
Cost-share is the percentage of the TRICARE-allowable charge that you're responsible for paying when you receive healthcare services. Unlike fixed copayments, cost-shares are calculated as a percentage and vary based on the total cost of care.
TRICARE Select cost-share rates: • Active Duty Family Members: 15% (network), 20% (non-network) • Retirees and families: 20% (network), 25% (non-network)
Example calculation If a specialist visit has an allowable charge of $200: • Network provider, ADFM: You pay $30 (15% of $200) • Non-network provider, retiree: You pay $50 (25% of $200)
Important notes: • TRICARE Prime uses primarily copays, not cost-shares • TRICARE Select uses cost-shares for most services • All cost-shares count toward your catastrophic cap • Network providers result in lower cost-shares
The cost-share model means higher-cost services result in higher out-of-pocket expenses, making it important to understand your potential costs before receiving care.
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 TRICARE options are available for Reserve and National Guard members?
Reserve and Guard members have TRICARE Reserve Select when not activated, and regular TRICARE when on active duty orders over 30 days.
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 pregnancy and maternity care?
TRICARE covers comprehensive maternity care including prenatal visits, delivery, postpartum care, and newborn care at no or low cost.
How do TRICARE and Medicare work together?
TRICARE For Life works with Medicare for beneficiaries 65+ who have both Medicare Part A and B, with Medicare paying first and TRICARE second.
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 does TRICARE cover autism spectrum disorder?
TRICARE covers autism diagnosis, ABA therapy, speech therapy, occupational therapy, and medication through the Comprehensive Autism Care Demonstration.
What are the cost shares for TRICARE Select?
TRICARE Select has annual deductibles, percentage-based cost shares for most services, and a catastrophic cap that limits yearly out-of-pocket costs.
How do TRICARE deductibles work?
TRICARE Select has annual deductibles that must be met before cost sharing begins. Individual and family deductibles vary by beneficiary group.
How can I estimate my TRICARE costs before getting care?
Use the TRICARE cost estimator tool online, review cost charts on TRICARE.mil, or call your regional contractor for specific procedure estimates.
What do mental health services cost under TRICARE?
Mental health costs are the same as other healthcare: active duty $0, Prime has low copays, Select has cost shares, and care counts toward the catastrophic cap.
What are the costs for prenatal care under TRICARE?
Active duty families have very low or no cost for prenatal care. Prime has copays; Select has cost shares after deductible is met.
Related Terms
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