TRICARE Copayment: Definition and 2026 Rates | TRICARE.com

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## Definition A copayment is a fixed dollar amount you pay out-of-pocket for a covered healthcare service or prescription medication, usually paid at the time of the visit.

## What it means in practice For most TRICARE beneficiaries, copayments are the primary way you share the cost of your medical care. Unlike a "coinsurance" (which is a percentage of the total bill), a copayment is a predictable, flat fee. For example, if your plan has a $38 copayment for a primary care visit, you pay exactly $38 regardless of whether the doctor spends ten minutes or thirty minutes with you, provided the service is covered.

Your specific copayment amounts depend on three main factors: your TRICARE plan (such as Select or Prime), your beneficiary category (Group A vs. Group B), and your sponsor’s status (Active Duty vs. Retiree). It is important to note that **Active Duty Service Members (ADSMs)** never pay copayments for covered care. However, their family members and retirees often do.

Under the current 2026 rates, TRICARE Select Group A retirees typically pay a higher fixed copayment than those in Group B. Common examples of 2026 copayments for a TRICARE Select Retiree (Group A) might include roughly $38 for a primary care visit or $48 for specialty care when using an in-network provider. Pharmacy copayments also apply; for instance, a 90-day supply of a brand-name maintenance drug via Express Scripts Home Delivery typically carries a fixed copayment (often around $48 in 2026).

Once you reach your **Catastrophic Cap** for the calendar year, you no longer have to pay copayments for covered services. All payments you make toward your copayments count toward hitting this cap.

## Related terms * **Cost-Share:** A form of cost-sharing where you pay a percentage of the total allowed amount (common in TRICARE Select for out-of-network care). * **Deductible:** A fixed amount you must pay out-of-pocket each year before TRICARE begins to pay for covered services. * **Catastrophic Cap:** The maximum dollar amount you or your family will pay out-of-pocket for covered TRICARE services each calendar year. * **Network Provider:** A healthcare professional or facility that has a contract with Humana Military (East) or TriWest (West) to provide care at negotiated rates. * **Point-of-Service (POS) Option:** An option for TRICARE Prime enrollees to see non-network providers without a referral, resulting in significantly higher copayments and deductibles.

## Sources * TRICARE.mil: [Cost Terms](https://www.tricare.mil/Costs/Cost-Terms) * Defense Health Agency: [TRICARE Costs and Fees Sheet](https://www.tricare.mil/publications) * Humana Military: [Payment and Costs](https://www.humanamilitary.com/beneficiary/plans-and-programs/costs) * TriWest Healthcare Alliance: [West Region Beneficiary Portal](https://www.triwest.com)