Below are just a handful of the co-pays and cost shares from covered services that you could be responsible for when using your TRICARE Select plan*.

Hospitalization (Out-of-Network)
$1,112/day or 25% of hospital charges

Mental Health (Inpatient, In-Network)
$250/day or 25% of hospital charges

Outpatient Visits (Primary, In-Network)
$34/visit 

Emergency Services
$138/occurrence or 25% if out of network

Ambulance
$100/occurrence or 25% if the ambulance is out of network

The figures above are for illustrative purposes only.

*Check with TRICARE to confirm your actual co-pay portion. TRICARE's portion of coverage is provided here for your convenience, but is subject to change by Defense Health Agency; visit https://tricare.mil/Costs/Compare for the most up-to-date information. The Supplement Insurance reimburses for co-pay costs for covered services after deductibles have been met.