![]() ![]() That’s why it's usually less expensive for you to use a network provider for your care. Since some plans have cost-shares that are a percentage of the charge, a lower rate helps keep your costs down. The contractors who manage care in the civilian network try to save you and the government money by making agreements with providers to accept less than the allowable charge for your care. For instance, if you have a surgery, you may have separate cost-shares for the facility, the surgeon, and the anesthesiologist. If you see several doctors as part of an appointment, or have additional tests, you may have more than one cost-share. (Doesn't apply to active duty service members) The percentage of the total cost of a covered health care service that you pay. So if your doctor runs blood work as part of your visit, or you have an EKG or other test covered by TRICARE, you normally won't have a separate copayment for those tests.Ĭost-share A percentage of the total cost of a covered health care service that you pay. TRICARE Select for services received from network providers.Ī copayment for an appointment also covers your costs for tests and other ancillary services you get as part of that appointment. TRICARE Prime and TRICARE Prime Remote (Doesn't apply to active duty service members) The fixed dollar amount you pay for a covered health care service or drug. Point-of-service fees for TRICARE Prime don't apply toward your catastrophic cap.įor premium-based plans, your monthly premiums don’t apply toward your catastrophic cap.Ĭopayment A fixed dollar amount you may pay for a covered health care service or drug. The most you pay out of pocket annually for TRICARE covered services.įees for covered services, including yearly (calendar year) enrollment fees, deductibles, copayments, pharmacy copayments, and other cost-shares based on TRICARE-allowable charges, apply toward your catastrophic cap. When you meet your individual deductible, TRICARE cost-sharing will begin. If you have a TRICARE Prime plan, you have to meet your annual deductible when using the point-of-service option. TRICARE For Life (for services not covered by both Medicare and TRICARE) The amount you must pay before cost-sharing begins. You can find more info at Annual deductible In some cases, federal law requires a set rate. Many rates vary based on location, since health care costs more in some places and less in others. TRICARE sets CHAMPUS Maximum Allowable Rate (CMAC) for most services. If you use a non-participating provider, you will have to pay all of that additional charge up to 15%. Non-participating providers can charge you up to 15% more than the allowable charge that TRICARE will pay. The maximum amount TRICARE will pay a doctor or other provider for a procedure, service, or equipment. This is tied by law to Medicare's allowable charges. ![]() TermĪllowable charge The maximum amount TRICARE pays for each procedure or service. Here are some definitions to help you better understand your costs with TRICARE.
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