Comparing TRICARE Prime And TRICARE Select. Under TRICARE Prime, the provider will file insurance claims for you in most cases. Under Select, network providers may file claims for you, but when getting non-network care, you may be required to file your. Starting on Jan. 1, 2021, TRICARE Select Group A retired beneficiaries must pay monthly enrollment fees in order to maintain their TRICARE health coverage. This is a change, and the first time this beneficiary group will pay enrollment fees. “In 2021, some TRICARE beneficiaries will pay enrollment fees for the first time, a change mandated. Testing copayment waiver: Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for medically necessary COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits during which tests are ordered or administered.
The catastrophic cap is the maximum out-of-pocket amount the beneficiary will pay each calendar year for TRICARE-covered services. The beneficiary is not responsible for any amounts over the catastrophic cap in a given year, except for:
- Services that are not covered.
- Point of Service charges.
- The additional 15 percent non-participating providers may charge above the TRICARE allowable charge.
If the beneficiary changes programs during the calendar year under the same sponsor, any amount credited toward the catastrophic cap will roll over to the new program (does not apply to Continued Health Care Benefit Program [CHCBP]).
A beneficiary's catastrophic cap is determined by the sponsor's initial enlistment or appointment date:
- Group A: Sponsor's enlistement or appointment date is before Jan. 1, 2018.
- Group B: Sponsor's enlistement or appointment date is on or after Jan. 1, 2018.
| Out-of-pocket expenses that apply towards cap | Out-of-pocket expenses that do NOT apply towards cap |
|---|---|
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Tricare Select Copay 2020 Application
2021 Catastrophic Cap Amounts
| 2021 | Group A | Group B |
|---|---|---|
| Active Duty Family Members (TRICARE Prime and Select) | $1,000 per family, per calendar year | $1,058 per family, per calendar year |
| Retirees and Their Family Members (TRICARE Prime) | $3,000 per family, per calendar year | $3,703 per family, per calendar year |
| Retirees and Their Family Members (TRICARE Select) | $3,500 per family, per calendar year | $3,703 per family, per calendar year |
| TRICARE Reserve Select (TRS) | $1,058 per family, per calendar year | |
| TRICARE Retired Reserve (TRR) | $3,703 per family, per calendar year | |
| TRICARE Young Adult (TYA) | Active Duty Family Members:$1,058 per individual, per calendar year Retiree Family Members: $3,703 per individual, per calendar year | |
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Tricare Prime Copay 2021
2020 Catastrophic Cap Amounts
Cost Of Tricare Prime 2020
| 2020 | Group A | Group B |
|---|---|---|
| Active Duty Family Members (TRICARE Prime and Select) | $1,000 per family, per calendar year | $1,044 per family, per calendar year |
| Retirees and Their Family Members (TRICARE Prime and Select) | $3,000 per family, per calendar year | $3,655 per family, per calendar year |
| TRICARE Reserve Select (TRS) | $1,044 per family, per calendar year | |
| TRICARE Retired Reserve (TRR) | $3,655 per family, per calendar year | |
| TRICARE Young Adult (TYA) | Active Duty Family Members:$1,044 per individual, per calendar year Retiree Family Members: $3,655 per individual, per calendar year | |