TRICARE Emergency Room Coverage & Costs (2026) | TRICARE.com

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## Quick answer TRICARE covers emergency room (ER) visits for true medical emergencies without requiring a prior referral, regardless of your plan. If you are Active Duty, you must notify your Primary Care Manager (PCM) within 24 hours of being admitted or treated to ensure follow-up care is authorized.

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 cause severe pain. Examples include chest pain, uncontrollable bleeding, broken bones, or sudden inability to breathe.

**Note:** If you have a minor injury (like a sore throat or small cut), use an **Urgent Care Center** instead. Emergency room visits for non-emergency issues may result in higher out-of-pocket costs or claim denials.

### Costs by Plan (2026 Rates) Costs for ER visits depend on your beneficiary status and your specific plan:

* **Active Duty Service Members (ADSMs):** $0 out-of-pocket at any hospital. However, you must follow up with your PCM. * **Active Duty Family Members (ADFMs):** * **TRICARE Prime:** $0 copay at network or non-network ERs. * **TRICARE Select:** Small fixed copay (estimated ~$100–$115 for 2026, varies by Group A or B). * **Retirees and Families:** * **TRICARE Prime:** Approximately $80–$100 per visit (2026 rates). * **TRICARE Select:** Roughly $150–$250 per visit (2026 rates) after the annual deductible is met. * **TRICARE For Life:** TRICARE typically pays second to Medicare. If Medicare covers the ER visit, TRICARE pays your remaining Medicare deductible and coinsurance.

### Regional Management Emergency care is managed by the regional contractor for your area: * **East Region:** Humana Military. * **West Region:** TriWest Healthcare Alliance. * **Overseas:** International SOS (Note: In foreign countries, you may have to pay upfront and file for reimbursement).

### Follow-up Care While the ER visit itself does not need a referral, any **follow-up care** (such as a specialist appointment or physical therapy) resulting from the ER visit **does** require a new referral from your PCM if you are enrolled in a Prime plan.

## Who this affects * **Active Duty Service Members:** Always covered, but must notify PCM within 24 hours. * **Active Duty Family Members:** Covered on Prime and Select; no referral needed for the ER. * **Retirees and their Families:** Covered, subject to plan-specific copays and deductibles. * **National Guard and Reserve:** Covered under TRICARE Reserve Select (TRS). * **TRICARE For Life (TFL) Beneficiaries:** Covered as secondary insurance to Medicare.

## Sources * **TRICARE.mil:** [Emergency Care Overview](https://tricare.mil/emergency) * **Humana Military (East):** [Claims and Emergency Care](https://www.humanamilitary.com/) * **TriWest Healthcare Alliance (West):** [Provider Network and Emergency Services](https://www.triwest.com/) * **Defense Health Agency (DHA):** [2026 Costs and Fees Sheet](https://tricare.mil/costs)