2021 Cost Information for Emergency Room Visits
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.
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- 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.
TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)
| Active Duty Family Members |
Retirees and Their Family Members |
|---|
Group A: $0
Group B: $0
|
Group A: $63
Group B: $63
|
TRICARE Select (not including TRICARE Young Adult)
| Active Duty Family Members |
Retirees and Their Family Members |
|---|
Group A:
Network Provider: $93
Non-Network Provider: 20%
Group B:
Network Provider: $42
Non-Network Provider: 20%
|
Group A:
Network Provider: $125
Non-Network Provider: 25%
Group B:
Network Provider: $84
Non-Network Provider: 25%
|
TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)
| TRS |
TRR |
|---|
Network Provider: $42
Non-Network Provider: 20% |
Network Provider: $84
Non-Network Provider: 25% |
TRICARE Young Adult (TYA)
| TYA Prime |
TYA Select |
|---|
| Active Duty Family Members |
Retiree Family Members |
Active Duty Family Members
|
Retiree Family Members |
| $0 |
$63 |
Network Provider: $42
Non-Network Provider: 20% |
Network Provider: $84
Non-Network Provider: 25% |
