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Covered Services

Tricare Prime Retired Copay

• Treat and release: When an ambulance treats you, but doesn’t take you to the hospital.
• Outpatient services. This includes:
  • Emergency transfers to or from your home, accident scene, or other location to a hospital.
• Inpatient services. This includes:
  • Ambulance transfers from a hospital-based emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. to a hospital more capable of providing the required care.
  • Transfers between a hospital or skilled nursing facility and another hospital-based or freestanding outpatient therapeutic or diagnostic department/facility.
• Air ambulance or boat ambulance transport when a land vehicle can't get to you, or when great distance or other obstacles are involved in transporting you to the nearest hospital with appropriate facilities. Your medical condition must require a speedy admission or indicate you can't be transferred by other means. The costs may differ from land ambulance.
• Joint response situations: When an ambulance crew needs the help of a paramedic or intermediate EMT to give you advanced life support services

TRICARE Prime® TRICARE Prime is a managed care option available in Prime Service Areas Geographic areas in the U.S. Where we offer TRICARE Prime. They ensure medical readiness of active duty by adding to the capability and capacity of military hospitals and clinics. TRICARE Prime is an HMO-style plan that uses a specific network of doctors. It guarantees appointments with participating providers within specific time standards. In most cases, TRICARE Prime care is delivered through military hospitals or clinics. TRICARE Prime is the only option available to active. Active duty service members (ADSMs) must be enrolled in Tricare Prime, while active duty family members (ADFMs) may choose to enroll in either Tricare Prime or Tricare Select. Retired servicemembers and their family members also have the choice between Tricare Prime and Tricare Select until they reach age 65, at which point they become eligible.

Payment of services and supplies provided by ambulance personnel at an accident scene may be allowed when your condition requires transfer to an inpatient acute setting and medical services and/or supplies are provided solely to stabilize your condition while awaiting the arrival of a more urgent means of transfer; e.g., air ambulance services.

TRICARE doesn't cover:

• Ambulance service you use instead of taxi service when your condition would have permitted use of regular private transportation
• Your transport or transfer to be closer to home, family, friends, or personal physician
• Medicabs or ambicabs that transport you to and from medical appointments

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 10/28/2020

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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.
• 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:

New Tricare Copays

• 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.

TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)

TRICARE Select (not including TRICARE Young Adult)

TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)

TRICARE Young Adult

Does Tricare Prime Cover Ambulance

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

Tricare Prime Hospital Copay