TRICARE is a health insurance program for military members, veterans, and their families. It covers over 9 million people. But, it’s not always free. You might have to pay deductibles, copayments, enrollment fees, or cost-shares.
This guide will explain TRICARE deductibles and costs. It will help you understand what you’ll pay and when.
TRICARE Plans Overview
TRICARE has different plans for various groups. These include active-duty service members, their families, retirees, and reservists. There are several costs to know:
- Deductibles: What you pay before your plan covers your medical costs.
- Copayments/Co-pays: Fixed costs for services like doctor visits or prescriptions.
- Cost-shares: A percentage of the bill you pay for services.
- Enrollment Fees: A yearly, quarterly, or monthly fee to keep your TRICARE coverage.
TRICARE Plans Breakdown
TRICARE has several plans, such as:
- TRICARE Prime (including US Family Health Plan, TYA Prime): A managed-care option with lower costs.
- TRICARE Select (including TYA Select, TRS, TRR, CHCBP): A more flexible option with higher costs.
- TRICARE Overseas Programs (Prime and Select): For those stationed outside the continental U.S.
- TRICARE for Life (TFL): Supplements Medicare for retirees aged 65+.
TRICARE Costs by Beneficiary Group
TRICARE costs depend on your beneficiary group. This is based on when you or your sponsor enlisted.
- Group A: Lower deductibles but higher out-of-pocket costs for those who enlisted before January 1, 2018.
- Group B: Higher enrollment fees but lower out-of-pocket costs for those who enlisted on or after January 1, 2018.
Annual Deductibles
A deductible is what you pay before your TRICARE plan starts covering services.
- TRICARE Prime: ADSMs and ADFMs (active duty family members) don’t pay deductibles unless using the POS option.
- TRICARE Select: Deductibles vary by rank and beneficiary group.
- Group A ADFMs have a $50 individual deductible.
- Group B ADFMs have a $52 individual deductible.
- Retirees and reservists have deductibles from $158 to $634, depending on in-network or out-of-network services.
Copayments and Cost-shares
- Copayment (Co-pay): This is a set amount you pay for medical services, like doctor visits.
- Cost-share: This is the percentage of the medical service cost you are responsible for paying after the deductible.
For example:
- TRICARE Prime beneficiaries in Group A pay $21 for a primary care visit, while Group B pays $21.
- TRICARE Select beneficiaries in Group A pay $22 in-network for a primary care visit, while Group B pays $15.
Annual Enrollment Fees
Enrollment fees help maintain your coverage. Not all TRICARE plans have them, but for those that do:
- TRICARE Prime:
- Group A Retirees: $303 for individuals, $606 for families.
- Group B Retirees: $366 for individuals, $732 for families.
- TRICARE Select:
- Group A Retirees: $150 for individuals, $300 for families.
- Group B Retirees: $474 for individuals, $948 for families.
TRICARE Prime Costs
TRICARE Prime provides managed care, similar to an HMO. Here’s a breakdown of common costs for Prime beneficiaries.
| Cost Type | Group A | Group B |
|---|---|---|
| Annual Enrollment Fee | $303 (individual), $606 (family) | $366 (individual), $732 (family) |
| Primary Care Visit | $21 | $21 |
| Specialty Care Visit | $31 | $31 |
| Emergency Room Visit | $63 | $63 |
| Hospitalization (Inpatient) | $158 per admission | $158 per admission |
Note: Active-duty members (ADSMs) and their families generally pay no costs unless using the Point-of-Service option, which allows them to seek care outside the Military Treatment Facility (MTF).
TRICARE Select Costs
TRICARE Select offers greater flexibility by allowing beneficiaries to choose from a wide network of civilian providers. Here are some typical costs.
| Service | Group A ADFMs | Group B ADFMs | Group A Retirees | Group B Retirees |
|---|---|---|---|---|
| Preventive Care Visit | $0 | $0 | $0 | $0 |
| Primary Care Visit (Network) | $22 | $15 | $30 | $26 |
| Specialty Care Visit (Network) | $34 | $26 | $46 | $42 |
| Emergency Room Visit | $93 | $42 | $125 | $84 |
| Inpatient Admission | $63 | $63 | $250/day (Network) | $185 (Network) |
TRICARE Pharmacy Costs
TRICARE beneficiaries have three main ways to get prescriptions filled:
- Military Pharmacies: Free for ADSMs and other TRICARE beneficiaries.
- TRICARE Home Delivery: Cost-effective for long-term medications.
- Retail Pharmacies: Cost varies depending on the drug’s status (generic, formulary, or non-formulary).
| Pharmacy Option | Generic Drug | Brand-name Drug | Non-formulary Drug |
|---|---|---|---|
| Military Pharmacy | $0 | $0 | Not available |
| Home Delivery (up to 90-day supply) | $10 | $29 | $60 |
| Retail Pharmacy (up to 30-day supply) | $13 | $33 | $60 |
TRICARE Catastrophic Cap
The catastrophic cap is the maximum amount you’ll have to pay for covered services in a given year. After you hit this limit, TRICARE pays 100% of the remaining costs.
- Group A ADFMs: $1,000 per family.
- Group B ADFMs: $1,058 per family.
- Retirees: $3,000 for Prime; $3,500 for Select.
Point-of-Service Costs
The Point-of-Service (POS) option allows beneficiaries to seek care outside the TRICARE network, but there are additional costs involved.
- Annual deductible: $300 (individual) and $600 (family).
- Cost-share: 50% of TRICARE allowable charges, with these payments not counting toward your catastrophic cap.
Supplemental Coverage
TRICARE Supplement insurance helps minimize out-of-pocket expenses for non-active duty beneficiaries. For as little as $12 a month, you can reduce or eliminate co-pays, cost-shares, and other out-of-pocket expenses.
Frequently Asked Questions (FAQs)
- Which TRICARE plan has no deductible?
TRICARE Prime has no deductible for services at a Military Treatment Facility (MTF). Those using the Point-of-Service option have a deductible of $300 for individuals and $600 for families. - What is the deductible for TRICARE for Life?
TRICARE for Life acts as secondary insurance for retirees 65+ enrolled in Medicare Parts A and B. There is no deductible for TRICARE for Life itself, though Medicare deductibles apply. - Do you have to pay a co-pay with TRICARE?
Yes, depending on the plan and service. For instance, TRICARE Prime retirees pay a $21 co-pay for primary care visits, while TRICARE Select members pay different amounts based on whether the provider is in-network or out-of-network.
Understanding TRICARE Deductibles and Costs
TRICARE offers robust health coverage to military members and their families, but understanding the associated costs can be complex. By knowing the deductibles, co-pays, cost-shares, and caps for your specific plan, you can better manage your healthcare expenses and maximize your TRICARE benefits.
