[Federal Register Volume 90, Number 215 (Monday, November 10, 2025)]
[Notices]
[Pages 50745-50747]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-19819]
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DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Calendar Year (CY) 2026 TRICARE Prime and TRICARE Select
Out-of-Pocket Expenses
AGENCY: Office of the Secretary, Department of Defense (DoD).
ACTION: Notice of CY 2026 TRICARE Prime and TRICARE Select out-of-
pocket expenses.
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SUMMARY: This notice provides the CY 2026 TRICARE Prime and TRICARE
Select out-of-pocket expenses.
DATES: The CY 2026 rates contained in this notice are effective January
1, 2026.
ADDRESSES: Defense Health Agency (DHA), TRICARE Health Plan, 7700
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Debra Fisher, 703-275-6224,
dha.ncr.healthcare-ops.mbx.thp-policy-and-programs-branch@health.mil.
SUPPLEMENTARY INFORMATION: The National Defense Authorization Acts for
Fiscal Years 2012 and 2017, and subsequent implementing regulations
(e.g., Sec. 199.17 of Title 32 of the Code of Federal Regulations),
established rates for TRICARE beneficiary out-of-pocket expenses and
how they may be increased by the annual cost of living adjustment
(COLA) percentage used to increase military retired pay or via budget
neutrality rules. The CY 2026 retiree COLA increase is 2.8%.
The DHA has updated the CY 2026 out-of-pocket expenses as shown
below:
Calendar Year 2026 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses Active Duty Family Members (ADFM)
Category
[Page 1 of 1]
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Prime * Prime *
Out of pocket expense Select Group A CY26 Select Group B CY26 Group A Group B
CY26 CY26
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Annual enrollment fee:
Individual....................... $0...................... $0..................... 0 0
Family........................... $0...................... $0..................... 0 0
Annual deductible:
E1-E4, individual................ $50..................... $66.................... 0 0
E1-E4, family.................... $100.................... $132................... 0 0
[[Page 50746]]
E5 & above, individual........... $150.................... $198................... 0 0
E5 & above, family............... $300.................... $397................... 0 0
Annual catastrophic cap.............. $1,000.................. $1,324................. 1,000 1,324
Preventive visit..................... $0...................... $0..................... 0 0
Primary care......................... $28 (IN); 20% (OON)..... $19 (IN); 20% (OON).... 0 0
Specialty care....................... $39 (IN); 20%(OON)...... $33 (IN); 20% (OON).... 0 0
ER visit............................. $103 (IN); 20% (OON).... $52 (IN); 20% (OON).... 0 0
Urgent care center visit............. $28 (IN); 20% (OON)..... $26 (IN); 20% (OON).... 0 0
Ambulatory surgery................... $25; (IN or OON)........ $33 (IN); 20% (OON).... 0 0
Ambulance, outpatient ground......... $88 (IN); 20% (OON)..... $19 (IN); 20% (OON).... 0 0
Ambulance, outpatient air............ 20%; (IN or OON)........ 20%; (IN or OON)....... 0 0
Durable medical equipment............ 15% (IN); 20% (OON)..... 10% (IN); 20% (OON).... 0 0
Inpatient admission.................. $24.50 per day; $25 min. $79 per adm. (IN); 20% 0 0
per admission. (OON).
Inpatient SNF/rehab facility......... $24.50 per day; $25 min. $33 per day (IN); $66 0 0
per admission. per day (OON).
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* When TRICARE Prime enrollees other than active duty service members self-refer to specialty or non-emergent
inpatient care without a referral from a network provider and/or authorization from the regional contractor,
the TRICARE Point of Service deductible and copayment applies in lieu of TRICARE Prime copayments.
Calendar Year 2026 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses Retiree Beneficiary Category
[Page 1 of 2]
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Prime * Prime *
Out of pocket expense Select Group A CY26 Select Group B CY26 Group A Group B
CY26 CY26
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Annual enrollment fee:
Individual....................... $186.96................. $594.96................ $381.96 $462.96
Family........................... $375.................... $1,191................. 765 927
Annual deductible:
Individual....................... $150.................... $198 (IN); $397 (OON).. 0 0
Family........................... $300.................... $397 (IN); $794 (OON).. 0 0
Annual catastrophic cap.............. $4,381.................. $4,635................. 3,000 4,635
Preventive visit..................... $0...................... $0..................... 0 0
Primary care......................... $38 (IN); 25% (OON)..... $33 (IN); 25% (OON).... 26 26
Specialty care....................... $52 (IN); 25% (OON)..... $52 (IN); 25% (OON).... 39 39
ER visit............................. $138 (IN); 25% (OON).... $105 (IN); 25% (OON)... 79 79
Urgent care center visit............. $38 (IN); 25% (OON)..... $52 (IN); 25% (OON).... 39 39
Ambulatory surgery................... 20% (IN); 25% (OON)..... $125 (IN); 25% (OON)... 79 79
Ambulance, outpatient ground......... $117 (IN); 25% (OON).... $79 (IN); 25% (OON).... 52 52
Ambulance, outpatient air............ 25%; (IN or OON)........ 25%; (IN or OON)....... 20 20
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Note: The calendar year catastrophic cap for TRICARE Select Group A retirees who are survivors of active duty
deceased sponsors or medically retired Uniformed Service members and their dependents is $3,000.
Calendar Year 2026 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses Retiree Beneficiary Category
[Page 2 of 2]
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Out of pocket expense Select Group A CY26 Select Group B CY26 Prime * Group A CY26 Prime * Group B CY26
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Durable medical equipment........... 20% (IN); 25% (OON).... 20% (IN); 25% (OON).... 20%............................ 20%.
Inpatient admission:
In-network...................... $250/day up to 25% of $231 per adm........... $198 per adm................... $198 per adm.
hospital charges, plus
20% of sep. billed
services.
Out of network.................. [Dagger] $1,306/day up 25%.................... $198 per adm................... $198 per adm.
to 25% of hosp.
charges, plus 25% of
sep. billed services.
[[Page 50747]]
Inpatient SNF/rehab facility........ $250/day up to 25% of $66 per day (IN); $39 per day.................... $39 per day.
hospital charges, plus lesser of $397 per day
20% of sep. billed or 20% (OON).
services (IN); 25%
(OON).
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[Dagger] This is the CY25 rate. The CY26 out of pocket expense will be available mid-December once the DRG payment rates are calculated.
* When TRICARE Prime enrollees other than active duty service members self-refer to specialty or non-emergent inpatient care without a referral from a
network provider and/or authorization from the regional contractor, the TRICARE Point of Service deductible and copayment applies in lieu of TRICARE
Prime copayments.
The CY 2026 rates contained in this notice are effective January 1,
2026.
Dated: November 5, 2025.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2025-19819 Filed 11-7-25; 8:45 am]
BILLING CODE 6001-FR-P