Bread Crumbs

Cost Shares for Retired Service Members, Their Families and All Others

  • You'll pay a cost share based on the type of care 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.

These costs are effective 10/1/2014.
Service Cost
Ambulance Services

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Ambulatory Surgery (Same Day)

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Behavioral Health (Inpatient)

In-Network: 20% of the total charge, plus 20% for separately billed services

Non-Network:

  • High-volume Hospitals: 25% hospital specific per diem, plus 25% for separately billed services
  • Low-volume Hospitals: $224 per day or 25% of the billed charges, whichever is less, plus 25% for separately billed services
  • Residential Treatment Center: 25% of the allowed amount
  • Partial Hospitalization: 25% of the allowed amount, plus 25% of the allowable charge for separately billed professional services
Behavioral Health (Outpatient)

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Clinical Preventive Services

$0 for the following services:

  • Cancer screenings* (colorectal, breast, cervical, prostate)
  • Immunizations*
  • Well-child care for children under age 6 (birth through age 5)

*This includes the office visit for beneficiaries age 6 and older when a covered cancer screening or immunization is provided during the visit.

For all other preventive services:

  • Network: 20% of negotiated fee
  • Non-Network: 25% of allowable charge
DME, Prosthetic Devices, Medical Supplies

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Emergency Services

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care)

Network: $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Non-Network: $764 per day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges

Immunizations $0
Laboratory and X-ray

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Maternity (office visits and hospitalization for delivery planned in a hospital in an inpatient setting)

Network: $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Non-Network: $764 per day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges

Note: This is one global fee for all of the maternity care and delivery.

Maternity (office visits for delivery planning in a TRICARE-authorized birthing center)

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Maternity (office visits for delivery planned at home or other setting)

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Newborn Care

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

Non-Network: The lower of the number of hospital days minus 3 multiplied by $764 or 25% of billed charges for institutional services, plus 25% for separately billed professional charges.

Outpatient Visit

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Skilled Nursing (Inpatient)

Network: $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Non-Network: 25% for institutional services, plus 25% cost share for separately billed professional charges

Only available in the U.S. and U.S. Territories.

Enrolled in TRICARE Young Adult?

Newborn care is not covered unless the father of the child is a uniformed service member.

Last Updated 3/10/2015