Coronavirus (COVID-19) Update:
Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. |
A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:
TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees. In response to the COVID-19 pandemic, the Defense Health Agency (DHA) is temporarily expanding telemedicine for specific benefits.
Service | Active Duty Family Members | Retirees and Their Family Members |
---|---|---|
Primary Care Outpatient Office Visits | Group A: $0 Group B: $0 | Group A: $21 Group B: $21 |
Specialty Care Outpatient (this includes physical, occupational | Group A: $0 Group B: $0 | Group A: $31 Group B: $31 |
Service | Active Duty Family Members | Retirees and Their Family Members |
---|---|---|
Primary Care Outpatient Office Visits | Group A: Network Provider: $22 Group B: Network Provider: $15 | Group A: Network Provider: $30 Group B: Network Provider: $26 |
Specialty Care Outpatient (this includes physical, occupational | Group A: Network Provider: $34 Group B: Network Provider: $26 | Group A: Network Provider: $46 Group B: Network Provider: $42 |
Service | TRS | TRR |
---|---|---|
Primary Care Outpatient Office Visits | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient (this includes physical, occupational | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |
Service | TYA Prime | TYA Select | ||
---|---|---|---|---|
Active Duty Family Members | Retiree Family Members | Active Duty Family Members | Retiree Family Members | |
Primary Care Outpatient Office Visits | $0 | $21 | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient Office Visits (this includes physical, | $0 | $31 | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |