Find Answers to Your TRICARE Cost Questions

TRICARE-allowable charge
This is the maximum amount TRICARE will pay a doctor or other provider for a procedure, service, or equipment. This applies to all TRICARE plans. According to the TRICARE Choices in the United States Handbook, “Nonparticipating non-network providers may charge up to 15% above the TRICARE-allowable amount.” Keep in mind, this doesn’t apply to your catastrophic cap, which we’ll touch on below.
Catastrophic Cap
The catastrophic cap is the most you pay out of pocket each year for TRICARE covered services. This includes costs, like enrollment fees, deductibles, copayments, and other cost-shares based on the TRICARE-allowable charge. Remember that not at all costs apply to the catastrophic cap. These exceptions include:

Annual deductible
A deductible is the amount you pay before cost-sharing actually begins. It applies to these plans:

Remember, if you’re enrolled in a TRICARE Prime plan, you have to meet your annual deductible when using the point-of-service option. This option allows non-ADSMs to see a TRICARE-authorized provider other than their primary care manager for any nonemergency services without a referral.
A cost-share is the percentage of the total cost of a covered health care service that you pay after your annual deductible is met (if a deductible applies to your plan). Sometimes you may have more than one cost-share, depending on the type of care you receive. An example of this would be if you see different doctors on the same day. Cost-shares aren’t applicable to ADSMs.
This is often mistaken for cost-share and vice-versa, but these two terms are different. The difference is that a copayment is a fixed dollar amount (for example, $30) that you pay for a covered service or prescription, whereas a cost-share is the percentage of the total cost (for example, 25%). Copayments also depend on your TRICARE plan, beneficiary category, group, the type of service you receive, and whether the service is provided by a network provider. 
Keep in mind, ADSMs don’t have any out-of-pocket costs. If you’re an active duty family member enrolled in a TRICARE Prime plan, you won’t have copayments unless you’re using the point-of-service option or filling a prescription outside of a military pharmacy.
Looking for more on this topic? Visit the TRICARE Cost Terms page for definitions. The TRICARE Costs and Fees Sheet and TRICARE Compare Cost Tool are also helpful if you need to see specific dollar amounts. And, of course, your TRICARE contractor is available if you have questions. By understanding cost terms, you can make informed health care decisions for you and your family.

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