Costs

Oct 28, 2020 Copayments for prescriptions available through Tricare's home delivery program also will remain the same, a 90-day supply of a generic drug delivered by mail will be $10, a brand-name medication. TRICARE retail network pharmacies At a retail network pharmacy, your copayments for up to a 30-day supply of generic formulary drugs will increase from $11 to $13. For brand-name formulary drugs, the increase is from $28 to $33. Non-formulary drugs will increase from $53 to $60.

• TRICARE Reserve Select (TRS) TRICARE Retired Reserve (TRR) 2020: E4 and Below: $52/individual, $104/family E5 and Above: $156/individual, $313/family. 2021: E4 and Below: $52/individual, $105/family.
• See full list on tricare.mil.
• Effective January 1, 2020 TRICARE costs will increase. Retirees with the TRICARE Prime benefit who do not carry Medicare Part B will also see small copay increases in some medical categories. In addition, these retirees will see a 1% increase in premiums. US Family Health Plan is a TRICARE Prime program so these increases apply to its members.

With the point-of-service option, you:

• Can visit any TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS
• Get routine care
• Don’t need a referral
• Pay more out of pocket (see fees below)

The point-of-service option doesn't apply if you:

• Are an active duty service member
• Use a non-Prime plan
• Have a referral. (If you have a referral and/or authorization, your costs are the same as network costs.)
• Have a newborn or adopted child (until enrolled in TRICARE Prime)
  • Note: Children are covered by TRICARE Prime for 90 days (120 days overseas) after birth or adoption as long as one other family member is enrolled. The point-of-service option won't apply to children during this time or until the date the contractor receives the enrollment form.
• Have other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as 'other health insurance.'
• Use the following type of care
  • Preventive care from a network provider in your region**
  • In some cases, urgent care

**If you visit a network provider in another region without a referral from your PCM, you're using the point-of-service option.

Point-of-Service Fees

When you use the point-of-service option, you’ll pay:

• Point-of-service fees instead of your regular copaymentA fixed dollar amount you may pay for a covered health care service or drug.
• Any other fees charged by non-network providers

These fees don’t apply to your annual catastrophic cap.

Last Updated 6/28/2019

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Annual deductibles apply to network and non-network providers for outpatient services only.

• Deductibles must be met before TRICARE benefits are payable.
• Once the deductible is met, cost-shares apply.
• Network providers can collect at a minimum the copayment at the time of service. A provider may also collect the outstanding balance of the deductible. The explanation of benefits (EOB) will inform the beneficiary and provider of the allowed amount and patient responsibility.
• Deductibles apply to the catastrophic cap.
• TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve deductibles do not apply to preventive services.
  • Exception: Deductibles will apply to routine eye examinations (when covered), school physicals and assignment-ordered physicals, when performed by non-network providers.

Tricare Cost Share 2021

A beneficiary's deductible 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)

Tricare Prime Copay 2020 Form

TRICARE Select (not including TRICARE Young Adult)

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

TRICARE Young Adult

TRICARE Costs And Fees 021

The TRICARE Young Adult deductible is based on the sponsor's status.

Tricare Prime Copay 2020 Part