Tricare Standard Copay

Posted : admin On 1/3/2022

Tricare Select is a fee-for-service insurance plan that lets you see any doctor. This plan is available to family members, veterans, and retirees.

  • . A yearly deductible before TRICARE cost-sharing will begin: $300 per individual/$600 per family. For services beyond this deductible, you pay 50% of the TRICARE-allowable charge. These costs do not apply to the catastrophic cap. TRICARE SELECT® (JAN. 31, 2021) Includes TRICARE Select, TRICARE Overseas Program.
  • Starting on Jan. 1, 2021, TRICARE Select Group A retired beneficiaries must pay monthly enrollment fees in order to maintain their TRICARE health coverage. This is a change, and the first time this beneficiary group will pay enrollment fees.
  • Visit www.tricare-west.com Provider Benefits & Copays for primary and specialty care copayment and cost-share amounts. The Defense Health Agency updates beneficiary out-of-pocket costs on an annual (calendar year) basis. Visit www.tricare-west.com Provider Benefits & Copays for primary and specialty care copay-ment and cost-share amounts.
Copays

The catastrophic cap is the maximum out-of-pocket amount the beneficiary will pay each calendar year for TRICARE-covered services. The beneficiary is not responsible for any amounts over the catastrophic cap in a given year, except for:

  • Services that are not covered.
  • Point of Service charges.
  • The additional 15 percent non-participating providers may charge above the TRICARE allowable charge.

If the beneficiary changes programs during the calendar year under the same sponsor, any amount credited toward the catastrophic cap will roll over to the new program (does not apply to Continued Health Care Benefit Program [CHCBP]).

A beneficiary's catastrophic cap is determined by the sponsor's initial enlistment or appointment date:

  • Group A: Sponsor's enlistement or appointment date is before Jan. 1, 2018.
  • Group B: Sponsor's enlistement or appointment date is on or after Jan. 1, 2018.
Out-of-pocket expenses that apply towards capOut-of-pocket expenses that do NOT apply towards cap
  • out-of-pocket deductibles
  • inpatient copayments or cost-shares
  • outpatient copayments or cost-shares
  • pharmacy medication costs
  • enrollment fees under TRICARE Prime and TRICARE Select plans
  • TRICARE Prime Point of Service deductible and cost-share amounts
  • payments for non-covered services
  • premiums paid under TRICARE Reserve Select, TRICARE Retired Reserve and TRICARE Young Adult

2021 Catastrophic Cap Amounts

2021Group AGroup B
Active Duty Family Members
(TRICARE Prime and Select)
$1,000 per family, per calendar year$1,058 per family, per calendar year
Retirees and Their Family Members
(TRICARE Prime)
$3,000 per family, per calendar year$3,703 per family, per calendar year
Retirees and Their Family Members
(TRICARE Select)
$3,500 per family, per calendar year$3,703 per family, per calendar year
TRICARE Reserve Select (TRS)$1,058 per family, per calendar year
TRICARE Retired Reserve (TRR)$3,703 per family, per calendar year
TRICARE Young Adult (TYA)Active Duty Family Members:$1,058 per individual, per calendar year
Retiree Family Members: $3,703 per individual, per calendar year
Tricare Standard Copay

2020 Catastrophic Cap Amounts

2020Group AGroup B
Active Duty Family Members
(TRICARE Prime and Select)
$1,000 per family, per calendar year$1,044 per family, per calendar year
Retirees and Their Family Members
(TRICARE Prime and Select)
$3,000 per family, per calendar year$3,655 per family, per calendar year
TRICARE Reserve Select (TRS)$1,044 per family, per calendar year
TRICARE Retired Reserve (TRR)$3,655 per family, per calendar year
TRICARE Young Adult (TYA)Active Duty Family Members:$1,044 per individual, per calendar year
Retiree Family Members: $3,655 per individual, per calendar year

Covered Services

Learn more about what we cover -
including health, dental, and pharmacy.
10/22/2019

On Jan. 1, some copayments for your prescription drugs will increase. If you get your prescriptions through the TRICARE Pharmacy Home Delivery or at a retail network pharmacy, you’ll pay anywhere from $2 to $7 more starting Jan. 1. Congress made this change in the National Defense Authorization Act for Fiscal YearOctober 1 - September 30 2018.

There’s still no cost to fill your prescriptions at military pharmacies. And these cost changes don’t apply to active duty service members (ADSMs). If you’re an ADSM, you still pay nothing for your covered drugs at military and network pharmacies.

“Military pharmacies remain to be your lowest cost option,” said U.S. Air Force Lt. Col. Melissa Pammer with the Pharmacy Operations Division at the Defense Health Agency. “Your next lowest cost is if you use the TRICARE Pharmacy Home Delivery.”

TRICARE Prescription Drug Categories

Tricare standard copay for physical therapy

Your prescription copayments vary based on pharmacy type. Also, they vary based on the drug category. TRICARE groups prescription drugs into one of four categories. This grouping is based on the medical and cost effectiveness of a drug compared to other drugs of the same type.

As outlined in the TRICARE Pharmacy Program Handbook, the drug categories include:

  • Generic formulary drugs: These drugs are widely available. You have the lowest out-of-pocket costs for these drugs.
  • Brand-name formulary drugs: These drugs are generally available to you. Plus, they offer you the second lowest copaymentA fixed dollar amount you may pay for a covered health care service or drug..
  • Non-formulary drugsA drug in a therapeutic class that isn’t as clinically or cost-effective as other drugs in the same class. You pay a higher cost share for these drugs.: These drugs may have limited availability. You have higher copayments for these drugs. Also, there’s generally an alternative formulary drug that you can get. It’s often more cost effective, and equally or more clinically effective.
  • Non-covered drugs: TRICARE doesn’t cover these drugs. If you choose to purchase a non-covered drug, you’ll pay 100% of the drug’s cost. These drugs are either not clinically effective, or as cost effective as other drugs offered. They may also pose a significant safety risk that may outweigh any potential clinical benefit.

To learn more, you can download the TRICARE Pharmacy Program Handbook from the Publications page.

Tricare Standard Copay

Pharmacy Copayment Increases

TRICARE Pharmacy Home Delivery

If you use home delivery, your copayments for up to a 90-day supply of generic formulary drugs will increase from $7 to $10. For brand-name formulary drugs, your copayments will increase from $24 to $29. Your copayments for non-formulary drugs when you don’t have a medical necessity will increase from $53 to $60.

Dermatologist

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.

Non-network pharmacies

Tricare Select Co Pay

At a non-network pharmacy, you must pay the full price of the drug. After meeting your annual deductible, you may submit a claim for partial reimbursement. Non-network pharmacy costs remain the same if you use TRICARE Prime. With TRICARE Prime, you’ll pay a 50% cost-shareA percentage of the total cost of a covered health care service that you pay. after meeting your point-of-service deductible for covered drugs.

For all other health plans, non-network pharmacy costs are as follows:

  • Generic formulary drugs and brand-name formulary drugs will cost $33 (up from $28) or 20% of the total cost, whichever is more, after you meet your annual deductible.
  • Non-formulary drugs will cost $60 (up from $53) or 20% of the total cost, whichever is more, after you meet your annual deductible.

Copayments for survivors of ADSMs are the same as the 2017 rates. The copayments remain the same for medically retired service members and their family members, too.

Tricare Standard Copay For Physical Therapy

For the latest TRICARE pharmacy costs, you should visit TRICARE Costs. To learn more about your pharmacy benefit, visit Pharmacy on the TRICARE website.

At the time of posting, this information is current. For the most recent information, contact your TRICARE contractor or local military hospital or clinic.

Tricare Standard Copay

Last Updated 2/17/2021