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. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees. Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. Note: Visit our Copayment.

• Visit www.tricare-west.com Provider Benefits & Copays for primary and specialty care copay-ment 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 copayment and cost-share amounts.
• A Brief Explanation of TRICARE Prime. TRICARE Prime is a comprehensive managed health care insurance plan that offers coverage for medical services that are deemed “medically necessary.” How does TRICARE define this? According to the official site, the requirement is that the medical care or a service is “appropriate, reasonable, and adequate for your condition and considered proven.”.
• 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 E5 and Above: $158/individual, $317/family.

• Copayments and cost-shares are subject to change at the beginning of each calendar year.
  • Copayments are per occurrence or per visit.
  • Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services.
• Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap.
• Point of Service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries (excluding active duty service members).

Important Note: Active duty service members do not have any out-of-pocket costs for care.

Tricare Prime Specialist Copay

2021 Costs

2021 Cost Information by Benefit

Detailed information on copayments and cost-shares is listed below by benefit. You can also view this information using the cost links in our Benefits A-Z list.

Tricare Prime Copay For Specialist

Costs

• Most costs are for calendar year 2021 unless noted separately.
• For US Family Health Plan and TRICARE Prime Remote costs, choose 'TRICARE Prime' from the pull-down menu
• Visit the Cost Terms page for definitions to help you better understand TRICARE costs.
• If you're an unremarried former spouse, for the Continued Health Care Benefit Program (CHCBP), chose 'Retired' regardless of your sponsor's status
• Looking for dental costs? Visit the TRICARE Dental Costs section.

Tricare Prime Specialist Copay Online

Tricare Prime Specialist Copay Card

Tricare Prime Specialist Copay Guide

Tricare Prime Co Pay Chart

Copayments will be waived retroactively to March 18 for certain testing and office visits related to the testing. The test must be one approved, cleared, or authorized by the Food and Drug Administration to detect SARS-CoV-2 or diagnose COVID-19. If you paid any copayments for testing related to COVID-19 and the resulting office visits with a network or non- network provider, you may file a claim for reimbursement. For more information related to the coronavirus, visit the FAQ page.