Outpatient - TRICARE Glossary Definition & Costs | TRICARE.com

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## Definition Outpatient care refers to medical procedures, tests, or treatments that do not require an overnight stay in a hospital or medical facility.

## What it means in practice For TRICARE beneficiaries, "outpatient" covers the vast majority of medical interactions, including primary care doctor visits, specialist consultations, laboratory blood work, X-rays, and even some "same-day" surgeries. Because you are not admitted to a hospital for at least 24 hours, these services are billed differently than inpatient care. The costs you pay—known as cost-shares or copayments—depend largely on your TRICARE plan (such as Prime or Select) and whether you are a Group A or Group B beneficiary.

In the TRICARE East region (managed by Humana Military) and the TRICARE West region (managed by TriWest Healthcare Alliance), outpatient services often require prior authorization for specialty care, though active duty service members (ADSMs) have different requirements than retirees or family members. For example, if you visit an Urgent Care center, that is considered an outpatient service. Under most plans, such as TRICARE Prime, active duty family members have a $0 copay for outpatient clinic visits at military hospitals, while retirees might pay a set fee at a civilian network provider.

For 2026, outpatient costs vary significantly by status. For example, a TRICARE Select Group A retiree might pay a 25% cost-share for an outpatient surgery at a civilian facility, while a TRICARE Prime retiree might pay a flat copayment of approximately $37 to $40 for a primary care outpatient visit (2026 rates). If you receive outpatient care at a Military Medical Treatment Facility (MTF), there is typically no out-of-pocket cost for any beneficiary category, though space is often limited for those not on Active Duty.

It is important to note that "observation status" can be a gray area. Sometimes a patient stays in a hospital bed for several hours or even overnight for observation, but the hospital still classifies the visit as outpatient. This distinction is critical because it determines whether your "Inpatient" or "Outpatient" deductible and cost-share rules apply.

## Related terms * **Inpatient:** Medical care that requires an admission to a hospital or facility for at least one overnight stay. * **Cost-Share:** The percentage of the total cost of a covered health care service that you pay after you have met your deductible. * **Copayment:** A fixed dollar amount you pay for a specific medical service, such as an outpatient doctor's visit. * **Catastrophic Cap:** The maximum out-of-pocket amount you will pay each year for covered TRICARE services. * **Prior Authorization:** A requirement that your provider gets approval from Humana Military or TriWest before providing certain outpatient services. * **Primary Care Manager (PCM):** The specific provider or clinic you see for basic outpatient care and referrals under TRICARE Prime.

## Sources * TRICARE.mil: [Outpatient Care](https://www.tricare.mil/CoveredServices/IsItCovered/OutpatientCare) * Defense Health Agency: [TRICARE Costs and Fees](https://www.tricare.mil/Costs) * TriWest Healthcare Alliance: [Provider Resources](https://www.triwest.com)