Tricare Prime Specialist Copay

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Costs

Find your TRICARE costs, including copayments,
enrollment fees, and payment options.

This page contains the link to the Benefits A-Z area which explains what is covered, excluded or has limitations.as well as important cost information.

A Brief Explanation of TRICARE Prime. TRICARE Prime is a comprehensive managed health care insurance plan that offers coverage for medical services that are deemed “medically necessary.” How does TRICARE define this? According to the official site, the requirement is that the medical care or a service is “appropriate, reasonable, and adequate for your condition and considered proven.”. TRICARE Reserve Select (TRS) TRICARE Retired Reserve (TRR) 2020: E4 and Below: $52/individual, $104/family E5 and Above: $156/individual, $313/family. 2021: E4 and Below: $52/individual, $105/family E5 and Above: $158/individual, $317/family. TRICARE Young Adult Prime $459 Not available TRICARE Young Adult Select $257 Not available When enrolled in a premium-based health plan (TRS, TRR, TYA Prime, TYA Select, or CHCBP), you pay a monthly or quarterly premium and follow Group B deductibles and applicable copayments or cost-shares. Quarterly Premium (Oct.

  • Most costs are for calendar year 2021 unless noted separately.
  • For US Family Health Plan and TRICARE Prime Remote costs, choose 'TRICARE Prime' from the pull-down menu
  • Visit the Cost Terms page for definitions to help you better understand TRICARE costs.
  • If you're an unremarried former spouse, for the Continued Health Care Benefit Program (CHCBP), chose 'Retired' regardless of your sponsor's status
  • Looking for dental costs? Visit the TRICARE Dental Costs section.
Humana tricare copaysSpecialist

Tricare Prime Co Pay

When did the sponsor enlist in or was appointed to the uniformed services?

Tricare Prime Copay For Specialist

Copayments will be waived retroactively to March 18 for certain testing and office visits related to the testing. The test must be one approved, cleared, or authorized by the Food and Drug Administration to detect SARS-CoV-2 or diagnose COVID-19. If you paid any copayments for testing related to COVID-19 and the resulting office visits with a network or non- network provider, you may file a claim for reimbursement. For more information related to the coronavirus, visit the FAQ page.

Coronavirus (COVID-19) Update:

  • Testing copayment waiver: Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for medically necessary COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits during which tests are ordered or administered. COVID-19 diagnostic and antibody tests must meet Families First Coronavirus Response Act (FFCRA) criteria in order to be eligible for the cost-share and copayment waivers.
  • Telemedicine copayment waiver: TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayment or cost-share. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees.

Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate.

Note: Visit our Copayment and Cost-Share Information page to view 2020 costs.
  • TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.
  • TRICARE Young Adult costs are based on the sponsor's status.
  • TRICARE Prime and TRICARE Young Adult Prime retirees have a separate copayment for allergy shots performed on a different day than the office visit, or performed by a different provider, such as an independent laboratory or radiology facility (even if performed on the same day as the related office visit).
  • Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost-share information, based on the TRICARE plan type.

A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:

Tricare prime specialist copay
  • Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
  • Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.

TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)

ServiceActive Duty Family MembersRetirees and Their Family Members
Primary Care Outpatient
Office Visits

Group A: $0

Group B: $0

Group A: $21

Group B: $21

Specialty Care Outpatient
Office Visits

(this includes physical, occupational
and speech therapy, and provisional coverage benefits)

Group A: $0

Group B: $0

Group A: $31

Group B: $31

TRICARE Select (not including TRICARE Young Adult)

ServiceActive Duty Family MembersRetirees and Their Family Members
Primary Care Outpatient
Office Visits

Group A:

Network Provider: $22
Non-Network Provider: 20%

Group B:

Network Provider: $15
Non-Network Provider: 20%

Group A:

Network Provider: $30
Non-Network Provider: 25%

Group B:

Network Provider: $26
Non-Network Provider: 25%

Specialty Care Outpatient
Office Visits

(this includes physical, occupational
and speech therapy, and provisional coverage benefits)

Group A:

Network Provider: $34
Non-Network Provider: 20%

Group B:

Network Provider: $26
Non-Network Provider: 20%

Group A:

Network Provider: $46
Non-Network Provider: 25%

Group B:

Network Provider: $42
Non-Network Provider: 25%

TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)

ServiceTRSTRR
Primary Care Outpatient
Office Visits		Network Provider: $15
Non-Network Provider: 20%		Network Provider: $26
Non-Network Provider: 25%

Specialty Care Outpatient
Office Visits

(this includes physical, occupational
and speech therapy, and provisional
coverage benefits)

Network Provider: $26
Non-Network Provider: 20%		Network Provider: $42
Non-Network Provider: 25%

TRICARE Young Adult (TYA)

Tricare Prime Specialist Copay Programs

ServiceTYA PrimeTYA Select
Active Duty Family MembersRetiree Family MembersActive Duty Family MembersRetiree Family Members
Primary Care Outpatient Office Visits$0$21Network Provider: $15
Non-Network Provider: 20%		Network Provider: $26
Non-Network Provider: 25%

Specialty Care Outpatient Office Visits

(this includes physical,
occupational and speech therapy, and provisional coverage benefits)

$0$31Network Provider: $26
Non-Network Provider: 20%		Network Provider: $42
Non-Network Provider: 25%