Tricare Prime Specialist Copay

Covered Services

• Tricare Prime is a managed service healthcare program for service members, reservists, dependents, and some retirees. More Tricare Prime Information Tricare Prime Coverage Details.
• The TRICARE Prime copay will only be charged to those service members and their families who are not active duty. However, there is a TRICARE Prime cost added if members use the point-of-service option. This happens when members fail to get a referral from their PCM for specialist services. They will, therefore, pay costs out-of-pocket as required.
• TRS members are covered under TRICARE Select. Benefits, cost-shares and deductibles are the same as Group B active duty family members. Enrollment Fees: $44.17/individual, $228.27/family (monthly) Annual Deductibles: E-4 and Below: $52/individual, $104/family.
• TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees. Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. Note: Visit our Copayment.

TRICARE covers proven services and supplies needed to diagnose and treat allergies.

TRICARE Young Adult Prime $459 Not available TRICARE Young Adult Select $257 Not available When enrolled in a premium-based health plan (TRS, TRR, TYA Prime, TYA Select, or CHCBP), you pay a monthly or quarterly premium and follow Group B deductibles and applicable copayments or cost-shares. Quarterly Premium (Oct.

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 6/18/2020

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Tricare Prime Specialist Copay

Tricare Select Copays

• Copayments and cost-shares are subject to change at the beginning of each calendar year.
  • Copayments are per occurrence or per visit.
  • Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services.
• Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap.
• Point of Service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries (excluding active duty service members).

Important Note: Active duty service members do not have any out-of-pocket costs for care.

2021 Costs

2021 Cost Information by Benefit

Detailed information on copayments and cost-shares is listed below by benefit. You can also view this information using the cost links in our Benefits A-Z list.