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Costs for Retirees, their Family Members, and Other Beneficiaries

When a service is covered by TRICARE but not Medicare you will be subject to the cost-shares below. Most commonly this happens for:

  • Extended inpatient hospital stays (longer than 150 days)
  • Care received outside of the U.S. and U.S. territories*

*Overseas providers are generally non-network, except in specific locations.

Retirees under 65 are eligible to enroll in TRICARE Prime if they live in a Prime Service Area. In this case, the costs below are replaced with the copays and cost-shares for TRICARE Prime.

These costs are effective 1/1/2018.
Service Cost
Annual Deductible $150 per individual, but no more than $300 per family
Ambulance Services Network: 20% of negotiated feeThe discounted rate network providers agree to accept for covered services.
Non-Network: 25% of allowable chargeThe maximum amount TRICARE pays for each procedure or service.  This is tied by law to Medicare's allowable charges.
Ambulatory Surgery (same day) 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, Pros. Dev., Med. Supp. 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 Not available outside the U.S. or U.S. territories.
Hospice Care Not available outside the U.S. or U.S. territories.
Hospitalization (Inpatient Care) (Medical and Mental Health)

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

Non-Network: $901 per day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges

Immunizations $0
Laboratory & X-ray

Labs ordered during a preventive service visit: $0

For all other lab and x-ray services:

  • Network: 20% of negotiated fee
  • Non-Network: 25% of allowable charge
Maternity (office visits & 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: $901 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) Not available outside the U.S. or U.S. territories.
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 $901 or 25% of billed charges for institutional services, plus 25% for separately billed professional charges.

Outpatient Visit (Medical and Mental Health) Network: 20% of negotiated fee
Non-Network: 25% of allowable charge
Skilled Nursing (inpatient) Not available outside the U.S. or U.S. territories.

Urgent Care

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

Last Updated 3/20/2018