2022 Retirees and Their Family Members Costs (Group A)
Note: Visit our Copayment and Cost-Share Information page for 2023 costs.
View the cost information below for retirees and their family members (not including TRICARE Young Adult) with sponsors who enlisted before Jan. 1, 2018.
| |
TRICARE Prime |
TRICARE Select |
|---|
| Enrollment Fees |
$323/individual, $647/family
(annually) |
$158/individual, $317/family
(annually)
Medically Retired or Survivor: $0 |
| Annual Deductibles |
$0 |
$150/individual, $300/family |
| Catastrophic Cap |
$3,000 per calendar year |
Retirees: $3,706 per calendar year
Medically Retired or Survivor: $3,000 per calendar year |
Note: Point-of-service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries.
Annual deductibles apply to outpatient services only.
| Type of Care |
TRICARE Prime |
TRICARE Select |
|---|
| Ambulance Services - Outpatient |
$44 |
Network Provider: $99
Non-Network Provider: 25% |
| Ambulatory Surgery |
$67 |
Network Provider: 20%
Non-Network Provider: 25% |
| Ancillary Services |
$0 |
Network Provider: $0
Non-Network Provider: 25% |
| Durable Medical Equipment |
20% |
Network Provider: 20%
Non-Network Provider: 25% |
| Emergency Room |
$67 |
Network Provider: $133
Non-Network Provider: 25% |
| Home Health Care |
$0* |
$0* |
| Hospice Care |
$0 |
$0 |
| Hospitalization - Physical Health |
$168 per admission |
Network Provider: Lesser of $250 per day or 25%,
plus 20% of professional fees
Non-Network Provider: Lesser of $1,053 per day or 25%,
plus 25% of professional fees |
| Hospitalization - Mental Health |
$168 per admission
|
Network Provider: Lesser of $250 per day or 25%,
plus 20% of professional fees
Non-Network Provider: Lesser of $1,053 per day or 25%,
plus 25% of professional fees |
| Laboratory and X-Rays |
$0 |
Network Provider: $0
Non-Network Provider: 25% |
| Maternity Care - Inpatient Delivery Setting |
$168 per admission |
Network Provider: Lesser of $250 per day or 25%,
plus 20% of professional fees
Non-Network Provider: Lesser of $1,053 per day or 25%,
plus 25% of professional fees |
| Office Visits - Primary Care |
$22 |
Network Provider: $32
Non-Network Provider: 25% |
| Office Visits - Specialty Care |
$33 |
Network Provider: $50
Non-Network Provider: 25% |
| Outpatient Mental Health Visits |
$33 |
Network Provider: $50
Non-Network Provider: 25% |
| Partial Hospitalization |
$33 per day** |
Network Provider: $50**
Non-Network Provider: 25% |
| Preventive Services - Eye Examinations |
$0 |
Not a covered benefit |
| Preventive Services - All Other Covered Services |
$0 |
$0 |
| Residential Treatment Center |
$33 per day |
Network Provider: Lesser of $250 per day or 25%,
plus 20% of professional fees
Non-Network Provider: 25% of allowable charges |
| Skilled Nursing Facility |
$33 per day |
Network Provider: Lesser of $250 per day or 25%,
plus 20% of professional fees
Non-Network Provider: 25% of allowable charges |
| Urgent Care Services |
$33 |
Network Provider: $32
Non-Network Provider: 25% |
*Costs may apply for durable medical equipment (DME) and medications/drugs.
**Copayment information is calculated per day for partial hospitalization programs and intensive outpatient treatment. Opioid treatment program services copayment is applied on a weekly basis.
