TRICARE Deductible Information

Annual deductibles apply to network and non-network providers for outpatient services only.

• Deductibles must be met before TRICARE benefits are payable.
• Once the deductible is met, cost-shares apply.
• Network providers can collect at a minimum the copayment at the time of service. A provider may also collect the outstanding balance of the deductible. The Explanation of Benefits (EOB) will inform the beneficiary and provider of the allowed amount and patient responsibility.
• Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services.
• Deductibles apply to the catastrophic cap.
• TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve deductibles do not apply to preventive services.
  • Exception: Deductibles will apply to routine eye examinations (when covered), school physicals and assignment-ordered physicals, when performed by non-network providers.

A beneficiary's deductible is determined by the sponsor's initial enlistment or appointment date:

• Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
• Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.

The TRICARE Young Adult deductible is based on the sponsor's status.