TRICARE Prime Out-of-Pocket Costs ADSMs, ADFMs, and transitional survivors Covered service Group A Group B All covered services $0 $0 Retirees, their families, and all others Covered service Group A Group B Preventive Care Visit $0 $0 Primary Care Outpatient Visit $20 $20 Specialty Care Outpatient Visit $31 $31 Urgent Care Center Visit $31 $31. Dec 02, 2019 Some copayments will increase as well; specialty and urgent care visits will cost $1 more in 2020. Tricare Prime users who are medically retired or survivors do not see an increase. Read more about. TRICARE Prime beneficiaries, except for active duty service members (ADSMs) enrolled in TRICARE Prime, do not need a referral for urgent care and Point of Service will not apply when seeking urgent care from the following: any network or non-network urgent care center (must be TRICARE-authorized) any network primary care type provider (family.
- Tricare Prime Urgent Care Copays
- Tricare Prime Urgent Care Copay Assistance
- Tricare Prime Urgent Care Costs
Coronavirus (COVID-19) Update:
Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. |
- TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.
- TRICARE Young Adult costs are based on the sponsor's status.
- TRICARE Prime and TRICARE Young Adult Prime retirees have a separate copayment for allergy shots performed on a different day than the office visit, or performed by a different provider, such as an independent laboratory or radiology facility (even if performed on the same day as the related office visit).
- Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost-share information, based on the TRICARE plan type.
A beneficiary's cost 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)
| Service | Active Duty Family Members | Retirees and Their Family Members |
|---|---|---|
| Primary Care Outpatient Office Visits | Group A: $0 Group B: $0 | Group A: $21 Group B: $21 |
Specialty Care Outpatient (this includes physical, occupational | Group A: $0 Group B: $0 | Group A: $31 Group B: $31 |
TRICARE Select (not including TRICARE Young Adult)
| Service | Active Duty Family Members | Retirees and Their Family Members |
|---|---|---|
| Primary Care Outpatient Office Visits | Group A: Network Provider: $22 Group B: Network Provider: $15 | Group A: Network Provider: $30 Group B: Network Provider: $26 |
Specialty Care Outpatient (this includes physical, occupational | Group A: Network Provider: $34 Group B: Network Provider: $26 | Group A: Network Provider: $46 Group B: Network Provider: $42 |
TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)
| Service | TRS | TRR |
|---|---|---|
| Primary Care Outpatient Office Visits | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient (this includes physical, occupational | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |
TRICARE Young Adult (TYA)
| Service | TYA Prime | TYA Select | ||
|---|---|---|---|---|
| Active Duty Family Members | Retiree Family Members | Active Duty Family Members | Retiree Family Members | |
| Primary Care Outpatient Office Visits | $0 | $21 | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient Office Visits (this includes physical, | $0 | $31 | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |
Covered Services
Learn more about what we cover -including health, dental, and pharmacy.
Tricare Prime Urgent Care Copays
During the COVID-19 crisis, you may have more questions than usual about where to seek care or even the level of care you need. Now is the time to learn the difference between emergency and urgent care, and the rules for your TRICARE health plan. That way, you can get the appropriate treatment you need.
Is this an emergency?
If you reasonably think you have an emergency, whether it’s related to COVID-19 or not, go to the nearest emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. or call 911. An emergency threatens your life, limb, or eyesight. Some emergency warning signs for COVID-19 include trouble breathing, continued chest pain or pressure, new confusion or inability to arouse, and bluish lips or face. If you develop any of these symptoms, get medical attention immediately. Be sure to let the emergency room or 911 dispatcher know in advance if you believe you have COVID-19.
'If you are otherwise healthy, a cough or sore throat doesn't generally require a trip to the emergency room,' said Dr. John Kugler, director of the Clinical Support Division at the Defense Health Agency (DHA). 'However, if your symptoms are getting worse or you are experiencing concerning symptoms such as trouble breathing or chest pain, don’t hesitate to seek medical attention right away.'
TRICARE covers emergency care. If you have a TRICARE Prime plan, you want to get in touch with your primary care manager or regional contractor within 24 hours, or the next business day after you receive care. If overseas and you need help, go to the closest emergency care facility or call the Medical Assistance number for your area.
When do I consider urgent care?
Urgent care might be an option for you if you don’t reasonably believe you have an emergency. Typically, urgent care is when you need care 24 hours before it becomes an emergency. Examples might include a cut without much blood that needs stitches or a sprained ankle. Most TRICARE beneficiaries can visit an urgent care center whenever needed, but you should follow the urgent care rules for your plan.
When possible, visit a TRICARE network provider or a TRICARE-authorized (network or non-network) urgent care center to avoid additional out-of-pocket costs. If you’re a family member or retiree and get urgent care from a non-network provider outside of a TRICARE-authorized urgent care center, you’ll have to pay point-of-service cost-shares. Check with your urgent care provider before going in person. There may be new processes in place because of COVID-19. Let them know if you believe you have COVID-19.
Active duty service members (ADSMs) enrolled in TRICARE Prime or TRICARE Overseas Program Prime should contact their military hospitals and clinics for urgent care. To seek civilian urgent care, ADSMs need a referral.
Should I Call the Military Health System (MHS) Nurse Advice Line?
If you aren’t clear whether your nonemergency injury or illness requires urgent care, you can contact the MHS Nurse Advice Line 24/7. Nurses can help you if you’re uncertain about the care you need. They can also help direct people who may have COVID-19 to the appropriate care. If you’re in the U.S., Guam, or Puerto Rico, call 1-800-874-2273 and choose option 1. You can find other country-specific numbers on the website.
If you’re enrolled in the US Family Health Plan (USFHP), you can’t use the MHS Nurse Advice Line. You must use the USFHP 24/7 Nurse Advice Line. Remember that you can also contact your health care provider for medical advice.
Use this information to help you get the appropriate care you need in the midst of the COVID-19 pandemic. Stay safe and take command of your health.
Tricare Prime Urgent Care Copay Assistance
Sign up for email alerts, and keep up with TRICARE and COVID-19 updates.
Tricare Prime Urgent Care Costs
Last Updated 4/15/2020