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Beneficiary Handbook
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Understanding TRICARE Costs and Fees
TRICARE Annual Deductible
TRICARE Prime Point-of-Service Option
Catastrophic Cap Benefit |
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UNDERSTANDING TRICARE COSTS AND FEES
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| Review the benefits and coverage charts in the section titled “What TRICARE Covers” for more information about specific cost-shares and copayments for TRICARE-covered services. |
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| TRICARE Annual Deductible |
| There is no annual deductible for TRICARE Prime or TRICARE Prime Remote (TPR) and TRICARE Prime Remote for Active Duty Family Members (TPRADFM). (However, there is a deductible if a TRICARE Prime or TPRADFM beneficiary exercises the point-of-service [POS] option.) |
TRICARE Extra and TRICARE Standard beneficiaries are required to meet an annual deductible for outpatient services. The deductibles are as follows:
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- Active duty family members E-4 and below: $50/person or $100/family per fiscal year
- All retirees and active duty family members E-5 and above: $150/person or $300/family per fiscal year
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| TRICARE Prime Point-of-Service Option |
| The TRICARE Prime POS option applies to all non-referred, nonemergency services received by TRICARE Prime and TPRADFM beneficiaries. The POS deductible applies only to outpatient services, and the cost-share applies to both inpatient and outpatient services. TRICARE reimbursement is limited to 50 percent of the TRICARE allowable charge. The POS option also applies to prescription drugs. If you take your prescription into a non-network pharmacy, you will pay more. POS cost-sharing and deductible amounts do not apply if you have OHI. The POS deductibles and cost-shares are as follows (for all beneficiary categories): |
Deductibles: $300 per individual/$600 per family
Cost-share: 50 percent of the TRICARE allowable charge
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| Catastrophic Cap Benefit |
| The catastrophic cap limits your out-of-pocket liability on copayments, cost-shares, and deductibles. The catastrophic cap by beneficiary category is as follows: |
- ADFMs using TRICARE Standard—$1,000 per fiscal year
- All other beneficiaries using TRICARE Standard (retirees, family members of retirees, survivors, former spouses)—$3,000 per family, per fiscal year
- ADFMs using TRICARE Prime—$1,000 per family, per fiscal year
- All other beneficiaries using TRICARE Prime (retirees, family members of retirees, survivors, former spouses)—$3,000 per fiscal year
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