TRICARE Mental Health Coverage Costs 2026 Guide | TRICARE.com

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## Quick answer TRICARE mental health coverage costs depend mainly on your beneficiary category (Group A or B) and your specific plan (Prime vs. Select). For Active Duty Service Members, mental health care is $0. For retirees and family members, 2026 copays typically range from $20 to $40 per outpatient visit on Prime, while Select members may pay a percentage of the allowable charge after meeting their deductible.

In detail

TRICARE provides comprehensive coverage for medically necessary mental health and substance use disorder services. While coverage is robust, the out-of-pocket costs are determined by how you are categorized and which regional contractor manages your care (Humana Military in the East; TriWest Healthcare Alliance in the West).

### TRICARE Prime Costs (2026) TRICARE Prime is a managed care option. If you follow the referral rules (getting a referral for non-emergency specialty care), your costs are generally lower.

* **Active Duty Service Members (ADSMs):** $0 for all covered mental health services. * **Active Duty Family Members (ADFMs):** $0 for outpatient visits (network). * **Retirees, their families, and others:** 2026 rates for individual outpatient visits are approximately **$39 per visit** for Group A and **$30 per visit** for Group B (check TRICARE.mil for slight inflationary adjustments).

### TRICARE Select Costs (2026) TRICARE Select offers more flexibility but higher out-of-pocket costs through deductibles and cost-shares.

* **ADFMs (Group A):** Approximately **$30–$40** per outpatient visit after the deductible is met. * **Retirees (Group A):** Approximately **$35–$55** per visit or 20% of the negotiated rate. * **Group B (Joined after Jan 1, 2018):** Often pay a flat copay (approx. **$21–$31** for ADFMs) rather than a percentage.

2026 Mental Health Cost Comparison Table

| Service Type | Prime (Retiree/Family) | Select (Retiree/Family) | | :--- | :--- | :--- | | **Outpatient Individual** | ~$39 (Group A) | ~$55 or 20% (Group A) | | **Inpatient (Mental Health)** | ~$171/day or $25 (whichever is greater) | Group A: ~$300/day or 20% | | **Partial Hospitalization** | $0 (ADFM) / ~$30 (Retiree) | 20% of allowable charge | | **Emergency Services** | ~$74 (Network) | ~20% after deductible |

### Important Rules for 2026 1. **Referrals:** ADSMs always need a referral for mental health care. For ADFMs and retirees on Prime, a referral is generally **not** required for office-based outpatient mental health visits with a network provider, but is required for intensive services like inpatient care or Residential Treatment Centers (RTC). 2. **Point of Service (POS):** If you are on Prime and see a mental health provider without a required referral, you will be charged POS fees, which include a $300 deductible and 50% cost-shares. 3. **Telemental Health:** TRICARE treats telemental health (video therapy) with the same cost-share as an in-person office visit.

## Who this applies to * **Active Duty Service Members:** Always $0 cost, but must stay within the military treatment facility (MTF) or have a crystal-clear referral to the network. * **Active Duty Family Members (ADFM):** Usually $0 on Prime; modest copays on Select. * **Retirees and their Families:** Subject to annual enrollment fees and per-visit copays. * **TRICARE Reserve Select (TRS) / Retired Reserve (TRRR):** These members follow the "Group B" Select cost-sharing structure.

Common scenarios

**Scenario 1: The Retiree on Prime (Group A)** John is a retired Army veteran living in the West Region (managed by TriWest). He sees a network psychologist once a week for PTSD. Because he is on TRICARE Prime Group A, he pays a **$39 copay** for each 2026 session.

**Scenario 2: The Active Duty Spouse on Select** Sarah is an active duty spouse on TRICARE Select Group A. She sees an out-of-network therapist because she prefers a specific provider. She must first meet her $150 annual deductible. After that, she pays **25% of the TRICARE allowable charge** for each session.

**Scenario 3: Inpatient Care for a Dependent** An active duty child requires treatment at a Residential Treatment Center (RTC). Because they are an ADFM on TRICARE Prime and received the necessary pre-authorization from Humana Military, the cost to the family is **$0**.

## Related terms * **Group A:** Beneficiaries whose initial enlistment or appointment occurred before Jan. 1, 2018. * **Group B:** Beneficiaries whose initial enlistment or appointment occurred on or after Jan. 1, 2018. * **Catastrophic Cap:** The maximum out-of-pocket amount you pay each year for covered TRICARE services. * **Point of Service (POS) Option:** A penalty-like cost-sharing structure for Prime members who seek non-emergency care without a referral. * **Allowable Charge:** The maximum amount TRICARE will pay for a covered health care service.

## Sources * **TRICARE.mil Costs:** https://www.tricare.mil/costs * **TRICARE Mental Health Overview:** https://www.tricare.mil/mentalhealth * **Humana Military (East):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West):** https://www.triwest.com/