TRICARE Emergency Care: Costs, Rules & 2026 Rates | TRICARE.com

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## Quick answer In a medical emergency, go to the nearest emergency room or call 911 immediately. You do not need prior authorization to seek emergency care, regardless of your TRICARE plan, but you must notify your Primary Care Manager (PCM) or regional contractor within 24 hours of admission to ensure your claims are paid correctly.

Details

### What Qualifies as an Emergency? TRICARE defines a medical emergency as a situation that a "prudent layperson" would consider a threat to life, limb, sight, or survivor. This includes severe bleeding, chest pain, shortness of breath, poisoning, or broken bones. If the situation is not life-threatening but requires attention within 24 hours, it is considered **Urgent Care**, which has different rules regarding authorization.

### Rules by Plan Type * **TRICARE Prime (Active Duty):** You must notify your PCM or regional contractor (**Humana Military** in the East; **TriWest** in the West) within 24 hours or the next business day if you are admitted to the hospital. Failure to do so may result in the care being processed under the Point-of-Service (POS) option, which has a much higher deductible. * **TRICARE Prime (All others):** Same notification rules apply. If you receive emergency care and are not admitted, you typically pay a flat copayment. * **TRICARE Select / TRS / TRR:** You can visit any TRICARE-authorized emergency room. No referral is required. Out-of-pocket costs are subject to your annual deductible and cost-shares.

### 2026 Costs and Copays Costs vary based on the beneficiary's "Group" (Group A joined before 2018; Group B joined on/after Jan 1, 2018). * **Active Duty Service Members:** $0 for all emergency care. * **Active Duty Family Members (Prime):** $0 for emergency room visits. * **Retirees (Prime):** Approximately $75–$80 per emergency room visit (varies by 2026 inflation adjustments). * **TRICARE Select (Group A):** Approximately $150+ per visit after deductible. * **TRICARE Select (Group B):** Approximately $100–$125 per visit after deductible. * *Note: If you are admitted to the hospital from the ER, the ER copay is usually waived, but you will pay the applicable inpatient cost-share.*

### Emergency Care Overseas If you are overseas, contact **International SOS**. If you are admitted, you must contact the TRICARE Overseas Program (TOP) Regional Call Center immediately to coordinate authorization and payment. Active duty members must contact their Primary Care Manager or the Nearest Military Treatment Facility (MTF) if possible.

### Psychiatric Emergencies Mental health emergencies are treated like physical emergencies. Go to the nearest ER. If you are admitted to a psychiatric facility, your regional contractor must be notified within 24 hours to authorize the stay.

## Who this affects * **Active Duty Service Members:** Must coordinate follow-up care with their PCM. * **Active Duty Family Members:** Covered under Prime or Select rules. * **Retirees and their Families:** Subject to copays and enrollment groups. * **National Guard and Reserve:** Covered when on active duty orders or if enrolled in TRICARE Reserve Select (TRS). * **TRICARE For Life (TFL) beneficiaries:** Medicare is primary; TRICARE is secondary for ER visits in the U.S.

## Sources * **TRICARE.mil:** [Emergency Care Overview](https://www.tricare.mil/CoveredServices/IsItCovered/EmergencyCare) * **Humana Military (East):** [Emergency and Urgent Care](https://www.humanamilitary.com/beneficiary/health-and-wellness/emergency-urgent-care) * **TriWest Healthcare Alliance (West):** [Emergency Room Care](https://www.triwest.com/en/beneficiary/getting-care/emergency-care/) * **DHA:** [TRICARE Costs and Fees](https://www.tricare.mil/Costs)