TRICARE Copay Guide: 2026 Rates & Costs | TRICARE.com

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## Quick answer A TRICARE copay is a fixed dollar amount you pay out-of-pocket for a covered healthcare service or prescription. Not everyone has them; active-duty service members pay $0, while retirees and families on Select or Prime (at civilian providers) typically pay set fees ranging from roughly $20 to $120 depending on the service and plan year.

## In detail Copays are part of your "cost-sharing" responsibility. Unlike a deductible (which is an amount you must pay before TRICARE pays anything), a copay is due at the time of service.

### Copays by Plan Type (2026 Rates) Your copay amount depends heavily on your beneficiary status and whether you are "Group A" (enlisted/commissioned before Jan. 1, 2018) or "Group B" (enlisted/commissioned on or after Jan. 1, 2018).

* **TRICARE Prime:** Generally has no copays for active-duty members. Active-duty family members pay $0 when using military hospitals or clinics. Retirees and their families pay small fixed copays when seen by a civilian provider in the Prime network. * **TRICARE Select:** Features higher copays than Prime but offers more flexibility in choosing providers. Costs differ significantly between Network and Non-Network providers. * **TRICARE Pharmacy:** Copays apply to almost everyone except active-duty service members. Costs are highest for brand-name drugs at retail pharmacies and lowest (often $0) for generics at military pharmacies.

### 2026 Estimated Copay Table (Group A, Retirees) | Service Type | Prime (Network) | Select (Network) | | :--- | :--- | :--- | | Primary Care Visit | ~$25 | ~$38 | | Specialty Care Visit | ~$37 | ~$50 | | Emergency Room | ~$75 | ~$146 | | Urgent Care | ~$37 | ~$38 | | Ambulatory Surgery | ~$75 | ~$115 |

*Note: These are estimated 2026 figures for Retired Category Group A. Active-duty families often have $0 copays for these services if using TRICARE Prime.*

### Important Rules 1. **Catastrophic Cap:** This is the most you will pay out-of-pocket for covered services in a calendar year. Once you hit this limit, your copays drop to $0 for the remainder of the year. 2. **Point-of-Service (POS):** If you are on TRICARE Prime and see a provider without a referral (when one was required), you will not pay a standard copay. Instead, you will pay a Point-of-Service penalty, which is usually 50% of the allowed charge. 3. **Network vs. Non-Network:** In TRICARE Select, using a non-network provider often converts your "copay" (fixed dollar) into "cost-shares" (a percentage of the total bill), which is almost always more expensive.

## Who this applies to * **Active Duty Service Members (ADSMs):** Generally does NOT apply. ADSMs have $0 out-of-pocket costs for clinical care. * **Active Duty Family Members (ADFMs):** Applies to those on TRICARE Select, or those on TRICARE Prime who see civilian providers for certain services. * **Retirees and their Families:** Applies to almost all services received from civilian network providers under both Prime and Select. * **TRICARE Reserve Select (TRS) / Retired Reserve (TRRR):** These members pay monthly premiums and have specific copay schedules similar to Select Group B.

Common scenarios

**Scenario 1: The Retiree Pharmacy Visit** John, a retired Navy veteran (Group A), picks up a 30-day supply of a brand-name maintenance medication at a Walgreens (Network Pharmacy). For 2026, his copay is **$38**. If he had used Express Scripts Home Delivery (Mail Order), his copay for a 90-day supply would be cheaper.

**Scenario 2: The Select Urgent Care Visit** Sarah is an Army spouse on TRICARE Select. She takes her daughter to a network Urgent Care Center. Under 2026 Select rates for Group A, Sarah pays a **$38 copay** at the front desk, and TRICARE covers the rest of the allowable charge.

**Scenario 3: The Prime Specialist Visit** Mark is a retired Air Force officer on TRICARE Prime. He receives a referral from his doctor to see a network cardiologist. At the specialist's office, Mark pays a **$37 copay** (2026 rate).

## Related terms * **Cost-Share:** A percentage of the total cost (e.g., 20%) you pay, rather than a fixed dollar amount. * **Deductible:** The fixed amount you must pay out-of-pocket each year before TRICARE begins to pay for covered services. * **Catastrophic Cap:** The maximum annual limit on out-of-pocket costs for TRICARE-covered medical services. * **Allowable Charge:** The maximum amount TRICARE will pay for a specific medical service or procedure. * **Point-of-Service (POS) Option:** A high-cost fee for Prime members who seek care without a required referral.

## Sources * **TRICARE.mil Costs:** https://www.tricare.mil/costs * **Defense Health Agency (DHA):** https://health.mil/ * **Humana Military (East Region):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West Region):** https://www.triwest.com/