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 In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Ambulatory Surgery (Same Day) In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Behavioral Health (Inpatient) In-Network:
20% of the total charge plus 20% for separately billed services

Out-of-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) In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Clinical Preventive Services $0 for colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6.

In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
DME, Prosthetic Devices, Medical Supplies In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Emergency Services In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care) In-Network:
$250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Out-of-Network:
$764 per day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges
Immunizations $0
Laboratory & X-ray In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting) In-Network:
$250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

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

Out-of-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) In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Maternity (office visits for delivery planned at home or other setting) In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Newborn Care In-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

Out-of-Network:
The lower of the number of hospital days minus 3 multiplied by DRG per diem copayment or 25% of billed charges for institutional services, plus 25% for separately billed professional charges.
Outpatient Visit In-Network: 20% of negotiated fee / Out-of-Network: 25% of allowable charge
Skilled Nursing (Inpatient) In-Network:
$250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

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

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

Last Updated 1/26/2015