TRICARE Allowable Charge: Definition & 2026 Guide | TRICARE.com

*TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy, please visit TRICARE.mil.*

## Definition The TRICARE Allowable Charge (TAC) is the maximum amount TRICARE will pay a provider for a specific medical service or piece of equipment.

## What it means in practice The Allowable Charge is the "ceiling" price for healthcare services. TRICARE determines this amount based on Medicare prevailing rates and other federal guidelines. When you receive a medical service, the total cost is split between TRICARE and you (the beneficiary), but the total of those two payments cannot exceed the Allowable Charge if the provider is "in-network" or "participating."

If you visit a **Network Provider**, they have agreed by contract to accept the Allowable Charge as full payment. For example, if a doctor normally charges $200 for a visit, but the TRICARE Allowable Charge is $150, the doctor must write off the $50 difference. You are only responsible for your specific cost-share or copayment (e.g., a $25 copay for TRICARE Prime for a 2026 specialist visit), and TRICARE pays the rest of that $150.

If you visit a **Non-Network, Non-Participating Provider**, you face more financial risk. These providers do not accept the Allowable Charge as full payment. They are legally allowed to charge up to 15% above the Allowable Charge—a practice known as "balance billing." In the previous example, if the Allowable Charge is $150, a non-participating provider could charge you $172.50. You would be responsible for your standard cost-share plus the extra $22.50.

Understanding the Allowable Charge is critical for TRICARE Select users, as out-of-network care can significantly increase out-of-pocket expenses beyond the standard deductible and cost-share percentages.

## Related terms * **Balance Billing:** When a non-participating provider bills a beneficiary for the difference between the TRICARE Allowable Charge and the provider’s actual billed amount. * **Cost-Share:** The percentage of the TRICARE Allowable Charge that a beneficiary pays (common in TRICARE Select). * **Copayment:** A fixed dollar amount a beneficiary pays for a specific service (common in TRICARE Prime). * **Catastrophic Cap:** The maximum out-of-pocket amount a beneficiary or family pays for covered services in a calendar year. * **Network Provider:** A doctor or facility that has a contract with Humana Military (East) or TriWest (West) to accept the Allowable Charge.

## Sources * **TRICARE.mil:** Cost Terms (https://www.tricare.mil/Costs/Cost-Terms) * **Defense Health Agency:** TRICARE Reimbursement Manual (https://manuals.health.mil/) * **Humana Military:** Provider Rates and Billing (https://www.humanamilitary.com)