TRICARE Cost Share Definition & 2026 Examples | TRICARE.com

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## Definition A cost-share is the fixed percentage (e.g., 20%) of the total allowed amount for a covered healthcare service that a TRICARE beneficiary must pay out-of-pocket after their annual deductible is met.

## What it means in practice While some TRICARE plans use "copayments" (a flat dollar amount like $30), plans such as TRICARE Select, TRICARE Reserve Select, and TRICARE Retired Reserve often utilize **cost-shares**. Under this model, the insurance company (Humana Military in the East or TriWest in the West) pays a majority of the bill, and you are responsible for a percentage of the "allowable charge."

For example, if you are a TRICARE Select Group A retiree in 2026 and you visit an out-of-network provider for a covered service that costs $200, your cost-share might be 25%. After you have met your annual deductible, you would pay $50, and TRICARE would pay the remaining $150. If you have not yet met your deductible, you would be responsible for the full $200 until that threshold is crossed.

It is important to note that cost-shares differ based on your beneficiary category (Group A vs. Group B) and whether you see a "Network" or "Non-Network" provider. Generally, seeing a non-network provider results in a significantly higher cost-share percentage. In 2026, most TRICARE Prime active-duty family members have a $0 cost-share for in-network care, whereas TRICARE Select beneficiaries should expect to see cost-shares for almost all outpatient visits and specialty care.

Your total annual "Catastrophic Cap" limits how much you will pay in cost-shares and copayments in a single calendar year. Once you hit that cap, TRICARE pays 100% of the allowable amount for covered services for the remainder of the year.

## Related terms * **Copayment:** A fixed dollar amount (e.g., $25) you pay for a specific medical service or prescription. * **Deductible:** The fixed amount you must pay out-of-pocket each year before TRICARE begins to share the costs of covered services. * **Allowable Charge:** The maximum amount TRICARE will pay for a specific procedure or service, which serves as the basis for calculating your cost-share percentage. * **Catastrophic Cap:** The maximum out-of-pocket limit a family or individual must pay for covered TRICARE services in a calendar year. * **Network Provider:** A doctor or facility that has a contract with Humana Military (East) or TriWest (West) to provide care at a pre-negotiated rate.

## Sources * TRICARE.mil: [Cost Terms](https://www.tricare.mil/Costs/Cost-Terms) * TRICARE.mil: [Compare Costs Tool](https://www.tricare.mil/Costs/Compare) * Defense Health Agency (DHA): [TRICARE Select Costs](https://www.tricare.mil/Select)