TRICARE Cost Matrix: 2026 Fees & Copays Guide
*Note: TRICARE.com is an independent reference site and is not the official TRICARE program or the Department of Defense. For official policy and enrollment, visit TRICARE.mil.*
## Quick answer The "Matrix" in the context of TRICARE refers to the **TRICARE Benefit Cost Matrix**, a comprehensive document that outlines exactly what you pay for various medical services across all plans. It breaks down copayments, cost-shares, and deductibles based on your beneficiary group (Group A or Group B) and your specific plan, such as TRICARE Prime or TRICARE Select.
## In detail Understanding the TRICARE Matrix is essential for budgeting your healthcare. Because military health benefits are complex, the Matrix serves as the "source of truth" for costs. These costs are updated annually by the Defense Health Agency (DHA).
### Beneficiary Groups: The Foundation of the Matrix Your costs in the Matrix are determined primarily by when you or your sponsor joined the military: * **Group A:** Sponsor’s initial enlistment or appointment was **before Jan. 1, 2018**. * **Group B:** Sponsor’s initial enlistment or appointment was **on or after Jan. 1, 2018**.
### 2026 TRICARE Cost Breakdown (Sample Rates) Below are examples of figures found in the 2026 Cost Matrix for Retirees and their families (Group A). Rates for active duty are typically $0 out of pocket.
| Service Category | TRICARE Prime (Network) | TRICARE Select (Network) | | :--- | :--- | :--- | | **Annual Deductible** | $0 | $191 Individual / $382 Family | | **Primary Care Visit** | $27 | $37 | | **Specialty Care Visit** | $37 | $53 | | **Emergency Room** | $75 | $145 | | **Urgent Care** | $37 | $37 | | **Catastrophic Cap** | $4,520 per family | $4,520 per family |
*Note: Group B beneficiaries typically face higher annual enrollment fees and slightly different copayments as defined in the 2026 Matrix updates.*
### Regional Variations While the Cost Matrix is standardized nationally, your claims are processed by the contractor for your region: * **TRICARE East:** Managed by Humana Military. * **TRICARE West:** Managed by TriWest Healthcare Alliance (as of the T-5 contract transition on Jan 1, 2025).
### Pharmacy Costs (Express Scripts) The Matrix also includes the pharmacy fee schedule. For 2026, typical costs for a 90-day supply via Home Delivery are: * **Generic:** ~$16 * **Brand-name:** ~$43 * **Non-formulary:** ~$92
## Who this applies to * **Active Duty Service Members:** Primarily for tracking the $0 cost-share at MTFs and civilian authorizations. * **Active Duty Families:** To distinguish between $0 Prime costs and Select cost-shares. * **Retirees and Families:** This group is most impacted by the Matrix, as they pay enrollment fees and per-visit copays. * **National Guard/Reserve:** Those on TRICARE Reserve Select (TRS) use the Matrix to identify their 20% cost-share for most services.
Common scenarios
### 1. The Group A Retiree Specialist Visit John is a retired Navy veteran (Group A) enrolled in TRICARE Prime. He sees a cardiologist in the TriWest (West Region) network. According to the 2026 Matrix, his fixed copayment is **$37**.
### 2. The Group B Active Duty Spouse ER Visit Sarah’s husband joined the Army in 2019 (Group B). She is enrolled in TRICARE Select. She visits a network Emergency Room for a non-emergency. Under the 2026 Matrix, her cost-share is a fixed **$104** (after her deductible is met).
### 3. Pregnancy and Delivery An Active Duty family on TRICARE Prime paying $0 for all covered maternity care as per the Matrix, compared to a Retiring family on Select who may pay a small per-day hospital charge.
## Related terms * **Catastrophic Cap:** The maximum out-of-pocket amount you pay each year for covered services. * **Cost-Share:** A percentage of the total treated cost you pay (common in TRICARE Select). * **Copayment:** A fixed dollar amount you pay for a specific service (common in TRICARE Prime). * **Point of Service (POS):** An option to see any provider without a referral, resulting in much higher costs than the standard Matrix rates. * **Premium:** The monthly fee paid to have coverage (e.g., for TRS or TRICARE Young Adult).
## Sources * **TRICARE.mil Costs:** [https://www.tricare.mil/costs](https://www.tricare.mil/costs) * **Defense Health Agency (DHA):** [https://health.mil/](https://health.mil/) * **Humana Military (East):** [https://www.humanamilitary.com/](https://www.humanamilitary.com/) * **TriWest Healthcare Alliance (West):** [https://www.triwest.com/](https://www.triwest.com/)