Back to Top Skip to main content

Know your costs before making a choice during TRICARE Open Season

Take Command of your health Take Command of Your Health

Recommended Content:

TRICARE Health Program | TRICARE Changes and You

TRICARE Open Season is underway. If you want to enroll in or change between TRICARE Prime and TRICARE Select health plans, you have until Dec. 10.

Active duty service members (ADSMs) are required to have TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime health coverage. Active duty family members (ADFMs), retirees, and eligible retiree family members can choose to have either TRICARE Prime or TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate. TRICARE Select coverage.

For many people, cost is a major factor in picking a health care plan. Before you choose a plan, make sure you know what’s covered and what it costs. To help you understand your potential health care costs, here are a few key TRICARE terms you should know.

  • TRICARE beneficiaries fall into one of two groups: Group A or Group B. Each group has different enrollment fees, deductibles, and out-of-pocket costs. You’re in Group A if your initial enlistment or appointment or that of your uniformed services sponsor began before Jan. 1, 2018. You’re in Group B if your initial enlistment or appointment or that of your uniformed services sponsor began on or after Jan. 1, 2018. When enrolled in TRICARE Reserve SelectA premium-based plan for qualified Selected Reserve members and their families.TRICARE Reserve Select, TRICARE Retired ReserveA preimum-based plan for qualified Retired Reserve members and their families.TRICARE Retired Reserve, TRICARE Young AdultA premium-based plan for qualified adult children.TRICARE Young Adult, or Continued Health Care Benefit Program follow Group B deductibles, copayments, cost-shares, and catastrophic caps regardless of when the uniformed services sponsor enlisted or was appointed.
  • An enrollment fee is the yearly amount you pay to enroll in TRICARE Prime or TRICARE Select. ADSMs and ADFMs don’t have an enrollment fee with TRICARE Prime. However, TRICARE Prime retirees, their families, and some others pay yearly enrollment fees. With TRICARE Select, ADFMs don’t pay enrollment fees, and neither do Group A retirees, their families, and others with TRICARE Select. However, Group B retirees, their families, and others pay yearly enrollment fees. Visit Health Plan Costs for more information.
  • A deductible is a fixed amount you pay for covered services each calendar year before TRICARE pays anything. You may have a deductible if you have TRICARE Select or if you have TRICARE Prime but see a provider without a referral.
  • A cost-share is a percentage of the total cost of a covered health care service that you pay after you pay your deductible.
  • A copayment is the fixed amount those with TRICARE Prime (who aren’t active duty) and TRICARE Select (for certain services) pay for a covered health care service or drug.
  • The catastrophic cap is the most you or your family will pay out of pocket for covered health care services each calendar year. When met, TRICARE pays your copayment or cost-share for covered health care services for the rest of the calendar year.
  • Point-of-service is an option under TRICARE Prime where you pay extra when getting nonemergency care from any TRICARE-authorized provider. The point-of-service option isn’t available to ADSMs.
  • The TRICARE-allowable charge is the maximum amount a participating TRICARE provider can be paid for a covered service. Learn more about TRICARE provider types.

Health care costs can differ based on who you are and your health plan option. For specific plan costs and dollar amounts, use the TRICARE Compare Cost Tool. Also, download the 2019 TRICARE Costs and Fees Sheet. If you want to enroll in or change your TRICARE health plan during TRICARE Open Season, take command of your health benefit by understanding your health care costs.

You also may be interested in...

Behind the scenes, DHA supports DOJ to fight compound drug fraud

Article
10/30/2020
Image of several large prescription bottles filled with pills

How DHA identifies and prevents profiting from fake prescriptions.

Recommended Content:

Health Readiness | Operation Live Well | TRICARE Health Program | Health Literacy Month 2020

Defense Health Agency celebrates seven years of service

Article
10/1/2020
Lt. Gen. Ronald Place holding a wreath at Arlington National Cemetery

Seven ways DHA has improved military readiness over the years.

Recommended Content:

Defense Health Agency | Coronavirus | MHS Transformation | Technology | Global Health Engagement | TRICARE Health Program | Total Force Fitness

MHS emphasizes importance of vaccinations

Article
7/22/2020
Healthcare worker giving vaccine to soldier; both wearing masks

Get questions answered during live Q&A on July 23

Recommended Content:

TRICARE Health Program | Coronavirus | Immunization Healthcare

DHA increases access to telehealth during COVID-19 pandemic

Article
5/19/2020
Medical personnel sitting at desk talking into laptop monitor

Use of telehealth role increases to prevent COVID-19 spread

Recommended Content:

TRICARE Health Program | Coronavirus

Possible changes at MTF pharmacies in response to COVID-19

Article
3/31/2020
A military pharmacist choosing medication from a shelf

Find out the latest pharmacy policies at MTFs

Recommended Content:

Coronavirus | Public Health | TRICARE Health Program

Achievements in 2019 provide strong foundation for year ahead

Article
12/23/2019
A Year in Review: Year of Military Health 2019

Dedication, commitment to mission praised as changes continue

Recommended Content:

TRICARE Health Program | MHS GENESIS | Research and Innovation | Preventive Health | MHS Transformation

New 3-D mammogram option the next step in diagnosis, treatment

Article
12/19/2019
Chief Hospital Corpsman Naomi Perez, a certified mammogram technician (left), conducts a mammogram for a patient at Naval Hospital Pensacola. A mammogram is a low-dose X-ray procedure used to detect the early stages of breast cancer. A policy change effective Jan. 1, 2020, will allow digital breast tomosynthesis, or 3-D mammography, to be used to screen for breast cancer. The procedure – known technically as Digital Breast Tomosynthesis (DBT) – will be offered primarily to women age 40 and older, and women age 30 and older who are considered high-risk for breast cancer.  The procedure’s 3-D images provide a more thorough means of detecting the disease. (U.S. Navy Photo by Mass Communication Specialist 1st Class Brannon Deugan)

Procedure would enhance effectiveness of breast cancer screening

Recommended Content:

TRICARE Health Program | Women's Health

Join Nov 21 TRICARE Webinar on Open Season

Article
11/15/2019
Take Command of Your Health

Be sure to make your choice for 2020 health coverage before open season ends on Dec. 9

Recommended Content:

TRICARE Health Program

Join TRICARE for Oct. 31 Q&A Facebook Event on Open Season

Article
10/28/2019
Take Command of Your Health

Do you have questions about open season? Here’s your chance to get some answers.

Recommended Content:

TRICARE Health Program | TRICARE Changes and You

2019 TRICARE Open Season, Federal Benefits Open Season starts soon

Article
10/24/2019
TRICARE Open Season and Federal Benefits Open Season happens only once a year. Unless you experience a Qualifying Life Event, open season is your only chance to enroll in or make a change to your enrollment for the participating programs. (DoD photo)

Open season is your chance to enroll in or make a change to your enrollment in the programs

Recommended Content:

TRICARE Health Program | TRICARE Changes and You

TRICARE website expands to include military hospital sites

Article
10/16/2019
The TRICARE website is growing. As of Oct. 1, TRICARE welcomed several military hospitals and clinics to its website.

By 2021, more than 350 individual military hospital and clinic websites will move to TRICARE.mil.

Recommended Content:

TRICARE Health Program | Military Hospitals and Clinics | TRICARE Changes and You

Bring your TRICARE benefit questions to September 26 webinar

Article
9/20/2019
U.S. Navy Reserve Lt. Cmdr. Jay Ross, a doctor of dental surgery, Operational Health Support Unit (OHSU) San Deigo, Calif., poses for a portrait during the Innovative Readiness Training Appalachian Care 2019, Aug 25, 2019, Wise, Virginia. (Photo by Staff Sgt. Jacob Cessna)

The Ask TRICARE webinar is one of many TRICARE resources to help you get answers to your questions

Recommended Content:

TRICARE Health Program

Get Ready: TRICARE Open Season, Federal Benefits Open Season begins Nov. 11

Article
9/16/2019
Take Command of Your Health

Now is the time to make changes to your current health, dental, and vision plan coverage

Recommended Content:

TRICARE Health Program | Dental Care

Join July 25 TRICARE webinar on TRICARE coverage after retirement

Article
7/18/2019
Will you or a family member be retiring soon? If so, you don’t want to miss this month’s webinar. (U.S. Navy photo)

When you retire from active duty or retire from the National Guard or Reserve, your TRICARE coverage will change

Recommended Content:

TRICARE Health Program | TRICARE Changes and You

Summer’s fun, just avoid too much sun

Article
6/25/2019
Soaking up the sun is one of the best parts about summer. However, make sure to protect your skin when enjoying the sun-filled days ahead. Too much unprotected exposure to the sun’s ultraviolet rays can cause sunburn, eye damage, and skin damage in the form of premature wrinkles. (DoD photo)

Make sure to protect your skin when enjoying the sun-filled days ahead

Recommended Content:

Summer Safety | TRICARE Health Program
<< < 1 2 > >> 
Showing results 1 - 15 Page 1 of 2

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.