2022 Retirees and Their Family Members Costs (Group B)
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 on or after Jan. 1, 2018.
| |
TRICARE Prime |
TRICARE Select |
|---|
| Enrollment Fees |
$392/individual, $784/family
(annually) |
$504/individual, $1,008/family
(annually) |
| Annual Deductibles |
$0 |
Network Providers: $168/individual, $336/family
Non-Network Providers: $336/individual, $672/family |
| Catastrophic Cap |
$3,921 per calendar year |
$3,921 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: $67
Non-Network: 25% |
| Ambulatory Surgery |
$67 |
Network: $106
Non-Network: 25% |
| Ancillary Services |
$0 |
Network: $0
Non-Network: 25% |
| Durable Medical Equipment |
20% |
Network: 20%
Non-Network: 25% |
| Emergency Room |
$67 |
Network: $89
Non-Network: 25% |
| Home Health Care |
$0* |
$0* |
| Hospice Care |
$0 |
$0 |
| Hospitalization (includes mental health) |
$168 per admission
|
Network Provider: $196 per admission
Non-Network Provider: 25% of allowable charges |
| Laboratory and X-Rays |
$0 |
Network Provider: $0
Non-Network Provider: 25% |
| Maternity Care - Inpatient Delivery Setting |
$168 per admission
|
Network: $196 per admission
Non-Network: 25% of allowable charges |
| Office Visits - Primary Care |
$22 |
Network: $28
Non-Network: 25% |
| Office Visits - Specialty Care |
$33 |
Network: $44
Non-Network: 25% |
| Outpatient Mental Health Visits |
$33 |
Network: $44
Non-Network: 25% |
| Partial Hospitalization |
$33 per day** |
Network: $44**
Non-Network: 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: $56 per day
Non-Network: Lesser of $336
per day or 20% of allowable charges |
| Skiilled Nursing Facilty |
$33 per day |
Network: $56 per day
Non-Network: Less of $336
per day or 20% of allowable charges |
| Urgent Care Services |
$33 |
Network: $44
Non-Network: 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.
