Inpatient

Inpatient care refers to healthcare services that require formal admission to a hospital or other medical facility for at least one overnight stay. TRICARE covers medically necessary inpatient services, though costs and requirements vary by plan and provider type.

Common inpatient services covered by TRICARE: • Surgical procedures requiring hospitalization • Childbirth and maternity care • Acute medical conditions requiring monitoring • Mental health and substance abuse treatment • Rehabilitation services • Cancer treatment requiring hospitalization

TRICARE inpatient cost-sharing: • TRICARE Prime: Low per-day copay or per-admission charge • TRICARE Select (Network): Cost-share based on allowable charges • TRICARE Select (Non-Network): Higher cost-share plus potential balance billing • Active duty: No cost for any inpatient care

Prior authorization requirements: • Non-emergency inpatient admissions typically require prior authorization • Emergency admissions must be reported within 24 hours or next business day • A Non-Availability Statement may be required if you live near an MTF • Your provider or hospital usually handles the authorization process

All inpatient cost-sharing counts toward your annual catastrophic cap, providing protection against excessive healthcare costs during serious illness or injury.