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TRICARE Transition Challenges in the West Region
We are aware of the customer service issues our patients are experiencing in the West Region. Learn more about how we are fixing these issues, including waiving our usual authorization process through March 18.

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Prime Network Copayments

Active Duty Service Members

  • You pay nothing out-of-pocket for any type of care

Active Duty Family Members

  • 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

All Other Beneficiaries

  • You pay the copayments below for care from TRICARE network providers
  • You pay nothing out-of-pocket for care received at a Military Treatment Facility, except where noted below
  • If you get care without a referral, 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

These costs are effective 1/1/2018.
Service Cost
Annual Deductible Network Providers: $0
Point-of-Service Option: $300 for individuals, $600 for family
Ambulance Services $40 per occurrence
Ambulatory Surgery (Same Day) $60
Mental Health (Inpatient) See TRICARE Mental Health Costs
Mental Health (Partial Hospitalization) See TRICARE Mental Health Costs

Mental Health (Outpatient)

See TRICARE Mental Health Costs
Clinical Preventive Services $0 from a network provider
DME, Prosthetic Devices, Medical Supplies 20% of the negotiated feeThe discounted rate network providers agree to accept for covered services.
Emergency Services $60 per visit
Home Health Care $0.

Note: You may have separate costs for additional services when receiving home health care. For example, DME, drugs, vaccines, orthotics/prosthetics, and nutritional therapy, among others.

Hospice Care $0
Hospitalization (Inpatient Care) MTF: $18.60 per day
Network Hospital: $150 per admission
Immunizations $0 from a network provider
Laboratory and X-ray Ancillary* services: $0
Other Radiology services: $0
Maternity (office visits and hospitalization for delivery planned in a hospital in an inpatient setting) Office Visits: $0
Delivery: $150
 
Maternity (office visits for delivery planning in a TRICARE-authorized birthing center) Office Visits: $0
Delivery: $60
 
Maternity (office visits for delivery planned at home or other setting)

Primary Care Provider: $20 per visit

Specialty Care Provider: $30 per visit
Newborn Care $0
Outpatient Visit Primary Care: $20 per visit
Specialty Care: $30 per visit
Skilled Nursing (Inpatient) $30 per day

Urgent Care

$30 per visit
*Ancillary services include:
  • Diagnostic radiology and ultrasound
  • Diagnostic nuclear medicine
  • Pathology and laboratory services
  • Cardiovascular studies
  • Venipuncture
  • Collection of blood samples
  • Fetal monitoring

Last Updated 12/18/2017