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2020 Retirees and Their Family Members Costs (Group A)

Note: Visit our Copayment and Cost-Share Information page for 2019 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 $300/individual, $600/family
(annually)
$0
Annual Deductibles $0 $150/individual, $300/family
Catastrophic Cap $3,000 per calendar year $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 $41 Network Provider: $90
Non-Network Provider: 25%
Ambulatory Surgery $62 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 $62 Network Provider: $118
Non-Network Provider: 25%
Home Health Care $0* $0*
Hospice Care $0 $0
Hospitalization - Physical Health $156 per admission Network Provider: Lesser of $250 per day or 25% of billed charges, plus 20% of professional fees
Non-Network Provider: Lesser of $953 per day or 25% of billed charges, plus 25% of professional fees
Hospitalization - Mental Health $156 per admission Network Provider: Lesser of $250 per day or 25% of billed charges, plus 20% of professional fees
Non-Network Provider: 25%
Laboratory and X-Rays $0 Network Provider: $0
Non-Network Provider: 25%
Maternity Care
(Office Visits and Delivery Planned in an Inpatient Setting)
$156 per admission Network Provider: Lesser of $250 per day or 25% of billed charges, 
plus 20% of professional fees
Non-Network Provider: Lesser of $953 per day or 25% of billed charges, plus 25% of professional fees
Office Visits (Primary Care) $20 Network Provider: $30
Non-Network Provider: 25%
Office Visits (Specialty Care) $31 Network Provider: $45
Non-Network Provider: 25%
Outpatient Mental Health Visits $31 Network Provider: $45
Non-Network Provider: 25%
Partial Hospitalization $31 per day** Network Provider: $45**
Non-Network Provider: 25%
Preventive Services (Eye Examinations) $0 Not a covered benefit
Preventive Services (All Other Covered Services) $0 $0
Residential Treatment Center $31 per day Network Provider: Lesser of $250 per day or 25% of billed charges, 
plus 20% of professional fees
Non-Network Provider: 25% of allowable charges
Skilled Nursing Facility $31 per day Network Provider: Lesser of $250 per day or 25% of billed charges, 
plus 20% of professional fees
Non-Network Provider: 25% of allowable charges
Urgent Care Services $31 Network Provider: $30
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.