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Cost Shares for Active Duty Family Members

You'll pay a cost share based on the type of care and provider you see (network vs. non-network). Non-network providers may charge up to 15% more than the TRICARE allowable charge. You're responsible for these extra charges. 

Some inpatient cost shares will change each fiscal year, starting October 1. The costs below start October 1, 2013.

Type of Care Network Provider Non-Network Provider
Ambulatory Care (Same Day Surgery) $25 per visit $25 per visit
Behavioral Health

Inpatient: $20 per day ($25 minimum)

Outpatient: 15% of the negotiated rate

Inpatient: $20 per day ($25 minimum)

Outpatient: 20% of the allowable charge

Home Health Care     $0 $0
Hospice Care $0 $0

Inpatient Services, such as:

  • Hospitalization
  • Skilled Nursing* 
$17.65 per day ($25 minimum)
$17.65 per day ($25 minimum)
Maternity Care

Global fee for office visits & 
hospitalization for delivery planned in a hospital: $17.65 ($25 minimum)

Office visits for delivery planned in a birthing center: $25 per visit

Office visits for delivery at home or another setting: 15% of the negotiated rate.

Global fee for office visits & 
hospitalization for delivery planned in a hospital: $17.65 ($25 minimum)

Office visits for delivery planned in a birthing center: $25 per visit

Office visits for delivery at home or another setting: 20% of the allowable.

Newborn Care

The lower of the number of hospital days minus 3 multiplied by $250 or 25% of the negotiated rate, plus 20% for separately billed professional charges.

The lower of the number of hospital days minus 3 multiplied by DRG per diem copayment or 25% of billed charges, plus 25% for separately billed professional charges.

Outpatient Services, such as:

15% of the negotiated rate 20% of the allowable charge

*Skilled Nursing is only available in the U.S. and U.S. Territories.

**The following Preventive Services are available free of charge: colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6.

Last Updated 4/10/2014