![]() ![]() TRICARE Prime and TRICARE Prime Remote (Doesn't apply to active duty service members) The fixed dollar amount you pay for a covered health care service or drug. Point-of-service fees for TRICARE Prime don't apply toward your catastrophic cap.įor premium-based plans, your monthly premiums don’t apply toward your catastrophic cap.Ĭopayment A fixed dollar amount you may pay for a covered health care service or drug. The most you pay out of pocket annually for TRICARE covered services.įees for covered services, including yearly (calendar year) enrollment fees, deductibles, copayments, pharmacy copayments, and other cost-shares based on TRICARE-allowable charges, apply toward your catastrophic cap. When you meet your individual deductible, TRICARE cost-sharing will begin. If you have a TRICARE Prime plan, you have to meet your annual deductible when using the point-of-service option. TRICARE For Life (for services not covered by both Medicare and TRICARE) The amount you must pay before cost-sharing begins. You can find more info at Annual deductible In some cases, federal law requires a set rate. Many rates vary based on location, since health care costs more in some places and less in others. TRICARE sets CHAMPUS Maximum Allowable Rate (CMAC) for most services. If you use a non-participating provider, you will have to pay all of that additional charge up to 15%. Non-participating providers can charge you up to 15% more than the allowable charge that TRICARE will pay. The maximum amount TRICARE will pay a doctor or other provider for a procedure, service, or equipment. This is tied by law to Medicare's allowable charges. TermĪllowable charge The maximum amount TRICARE pays for each procedure or service. Here are some definitions to help you better understand your costs with TRICARE. ![]()
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