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2020 Cost Information for Ambulance (Ground) Services

Note: Visit our Copayment and Cost-Share Information page to view 2019 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.
  • 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:

  • 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.

 

Outpatient costs are applied to the following transports:

  • beneficiary's residence, accident scene or other location to a military or VA hospital, or skilled nursing facility (SNF)
  • hospital or SNF to the beneficiary's residence

Inpatient costs are applied to the following transports:

  • between hospitals or SNFs
  • emergency room or civilian hospital to a military or VA hospital
  • emergency room to a hospital more capable of providing the required level of care

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

Active Duty Family Members Retirees and Their Family Members

Group A: 

Outpatient: $0
Inpatient: $0

Group B:

Outpatient: $0
Inpatient: $0

Group A: 

Outpatient: $41
Inpatient: 25%

Group B:

Outpatient: $41
Inpatient: 25%

TRICARE Select (not including TRICARE Young Adult)

Active Duty Family Members Retirees and Their Family Members

Group A: 

Outpatient:

Network Provider: $68
Non-Network Provider: 20%

Inpatient: 20%

Group B:

Outpatient:

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

Inpatient: 20%

Group A:

Outpatient:

Network Provider: $90
Non-Network Provider: 25%

Inpatient: 25%

Group B:

Outpatient:

Network Provider: $62
Non-Network Provider: 25%

Inpatient: 25%

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

TRS TRR

Outpatient:

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

Inpatient: 20%

Outpatient:

Network Provider: $62
Non-Network Provider: 25%

Inpatient: 25%

TRICARE Young Adult (TYA)

TYA Prime TYA Select
Active Duty Family Members Retiree Family Members Active Duty Family Members Retiree Family Members
Outpatient: $0
Inpatient: $0
Outpatient: $41
Inpatient: 25%

Outpatient:

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

Inpatient: 20%

Outpatient:

Network Provider: $62
Non-Network Provider: 25%

Inpatient: 25%