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.
What are the TRICARE costs for 2026?
TRICARE 2026 costs vary by plan and beneficiary group. Active duty members pay nothing, while retirees pay enrollment fees, copays, and deductibles that are adjusted annually.
Does TRICARE cover telehealth visits?
Yes, TRICARE covers telehealth and virtual care visits for a wide range of medical and mental health services with the same cost-shares as in-person visits.
Can I have TRICARE and employer insurance at the same time?
Yes, you can have both TRICARE and employer-sponsored health insurance. TRICARE coordinates benefits with other health insurance (OHI), which can reduce your out-of-pocket costs.
What is the TRICARE catastrophic cap for 2026?
The TRICARE catastrophic cap is the annual limit on out-of-pocket expenses. For 2026, active duty families pay no more than $1,000, while retiree family caps range from approximately $3,500 to $4,500.
Does TRICARE cover nursing home care?
TRICARE covers skilled nursing facility care on a short-term basis when medically necessary after hospitalization. Long-term custodial care and assisted living are not covered.
Do I need travel insurance if I have TRICARE?
TRICARE provides some coverage while traveling within the U.S. and limited coverage overseas. Supplemental travel insurance may be needed for medical evacuation and non-covered services abroad.
Does TRICARE cover weight loss programs?
TRICARE covers medically necessary weight loss treatments including bariatric surgery (with strict criteria), nutrition counseling, and obesity screening. Commercial weight loss programs are not covered.
Does TRICARE cover home births?
TRICARE covers home births when attended by a TRICARE-authorized certified nurse-midwife (CNM). The pregnancy must be low-risk, and specific requirements must be met for coverage.
Does TRICARE cover ambulance and air evacuation?
Yes, TRICARE covers ground and air ambulance services when medically necessary. Coverage includes emergency transport, inter-facility transfers, and air evacuation for critical situations.
Does TRICARE cover braces?
TRICARE does not cover braces for cosmetic purposes, but orthodontic treatment may be covered through the TRICARE Dental Program for dependents when medically necessary.
Does TRICARE cover weight loss surgery?
Yes, TRICARE covers bariatric surgery including gastric bypass and sleeve gastrectomy when specific medical criteria are met and pre-authorization is obtained.
Does TRICARE cover hearing aids?
Yes, TRICARE covers hearing aids and related services when prescribed by an authorized provider for diagnosed hearing loss.
Does TRICARE cover dental implants?
TRICARE medical covers dental implants only when they are related to a medical condition such as trauma or cancer treatment. The TRICARE Dental Program may cover implants with limitations.
Does TRICARE cover bariatric surgery?
Yes, TRICARE covers bariatric surgery for beneficiaries who meet strict medical criteria including BMI requirements, failed conservative treatment, and pre-authorization.
Does TRICARE cover breast reduction?
TRICARE covers breast reduction surgery when it is medically necessary to treat physical symptoms such as chronic pain, skin infections, or nerve damage caused by disproportionately large breasts.
Does TRICARE cover vasectomy?
Yes, TRICARE covers vasectomy as a covered surgical benefit. Standard copays and cost-shares apply based on plan type and provider network status.
Does TRICARE cover tubal ligation?
Yes, TRICARE covers tubal ligation (female sterilization) as a covered surgical and preventive care benefit with no cost-share for most beneficiaries.
Does TRICARE cover hospice care?
Yes, TRICARE covers hospice care for terminally ill beneficiaries with a life expectancy of six months or less, including pain management, counseling, and bereavement support.
Does TRICARE cover skilled nursing facility care?
Yes, TRICARE covers skilled nursing facility (SNF) care when medically necessary, typically following a hospital stay, with pre-authorization required.
Does TRICARE cover birth control?
Yes, TRICARE covers all FDA-approved birth control methods including oral contraceptives, IUDs, implants, injections, and emergency contraception at no cost-share.
Does TRICARE cover annual physicals?
Yes, TRICARE covers annual preventive health exams at no cost-share for all beneficiaries, including age-appropriate screenings and immunizations.
What is TRICARE Select?
TRICARE Select is a self-managed preferred provider plan similar to a PPO that offers more flexibility in choosing providers without referrals, but with higher out-of-pocket costs.
What is the TRICARE catastrophic cap?
The catastrophic cap is the maximum amount a TRICARE beneficiary family will pay out of pocket for covered services in a fiscal year, after which TRICARE pays 100%.
What is an EOB in TRICARE?
An EOB (Explanation of Benefits) is a statement from TRICARE that details the services billed, amounts paid by TRICARE, and any remaining costs the beneficiary owes.
What is TRICARE Reserve Select?
TRICARE Reserve Select (TRS) is a premium-based health plan available to qualified members of the Selected Reserve and their families who are not on active duty orders.
What is CHCBP?
CHCBP (Continued Health Care Benefit Program) is a temporary transitional health coverage program for people losing TRICARE eligibility, lasting 18 to 36 months.
What is the TRICARE Dental Program?
The TRICARE Dental Program (TDP) is a voluntary dental insurance plan for TRICARE-eligible family members and retirees, administered by United Concordia Companies.
What is a network provider in TRICARE?
A network provider is a doctor, hospital, or other healthcare provider that has a contract with a TRICARE regional contractor to provide services at negotiated rates.
What is a non-network provider in TRICARE?
A non-network provider is a TRICARE-authorized provider who does not have a contract with the regional contractor, resulting in higher costs and the beneficiary potentially filing their own claims.
What is a point-of-service option in TRICARE?
The point-of-service option allows TRICARE Prime enrollees to see non-network providers without a referral, but with significantly higher out-of-pocket costs.
What is TRICARE Retired Reserve?
TRICARE Retired Reserve (TRR) is a premium-based health plan for retired Reserve and Guard members who are under age 60 and not yet eligible for regular TRICARE retiree coverage.
What is cost-sharing in TRICARE?
Cost-sharing in TRICARE refers to the portion of healthcare expenses that beneficiaries pay out of pocket, including enrollment fees, deductibles, copays, and cost-shares.
What is TRICARE Extra?
TRICARE Extra was a former preferred provider option that offered discounts for using network providers. It was replaced by TRICARE Select on January 1, 2018.
What is TRICARE Standard?
TRICARE Standard was the former fee-for-service health plan that allowed beneficiaries to see any TRICARE-authorized provider. It was replaced by TRICARE Select on January 1, 2018.
How to find a TRICARE dentist?
Search the United Concordia provider directory online or call their customer service to find a dentist participating in the TRICARE Dental Program in your area.
How to check TRICARE claim status?
Check your TRICARE claim status online through your regional contractor's website, through milConnect, or by calling your contractor's customer service line.
How to use TRICARE with other insurance?
When you have both TRICARE and other health insurance (OHI), the other insurance typically pays first and TRICARE pays second, reducing or eliminating your out-of-pocket costs.
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