Prime Network Copayments

If you’re an active duty service member or their family:

  • You pay nothing out-of-pocket for any type of care
  • Unless you get care without a referral, then you will pay point-of-service charges

If you are anyone else:

  • You pay the copayments below for care from TRICARE network providers
  • If you get care without a referral, then you will pay point-of-service charges
  • Your costs are for care from civilian primary care managers (PCMs), or for care received with a PCM referral, when required
Type of Care  Cost 
Ambulance Services $20 per occurance
Ambulatory (Same Day) Surgery  $25 per visit 
Behavioral Health

Outpatient

  • $25 (individual visit)
  • $17 (group visit)

Inpatient

  • $40 per day (no charge for separately billed professional charges)
Clinical Preventive Services  $0
Durable Medical Equipment, Prosthetics, Orthotics & Supplies  Cost share is 20% of the negotiated fee
Emergency Room Visit  $30 per visit
Home Health Care $0
Hospice Care  $0
Hospitalization  $11 per day ($25 minimum)
Lab & X-Ray Services $12 per visit (unless billed as a clinical preventive service)
Maternity Care

Office visits and hospitalization and a hospital. (One global fee): $11 per day ($25 minimum)

Officed visits for delivery in a TRICARE-authorized birthing center: $25 per visit

Office visits for delivery planned at home or other setting: $12 per visit

Newborn Care $11 per day ($25 minimum)
Outpatient Visit  $12 per visit
Skilled Nursing Care $11 per day ($25 minimum)

Last Updated 10/14/2014