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TRICARE; Calendar Year (CY) 2026 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses

This notice provides the CY 2026 TRICARE Prime and TRICARE Select out-of-pocket expenses.

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Department of Defense

Office of the Secretary

AGENCY:

Office of the Secretary, Department of Defense (DoD).

ACTION:

Notice of CY 2026 TRICARE Prime and TRICARE Select out-of-pocket expenses.

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., § 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]
Out of pocket expense	Select Group A CY26	Select Group B CY26	Prime * Group A CY26	Prime * Group B CY26
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
( printed 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. per admission	$79 per adm. (IN); 20% (OON)	0	0
Inpatient SNF/rehab facility	$24.50 per day; $25 min. per admission	$33 per day (IN); $66 per day (OON)	0	0
* 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]
Out of pocket expense	Select Group A CY26	Select Group B CY26	Prime * Group A CY26	Prime * Group B CY26
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
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]
Out of pocket expense	Select Group A CY26	Select Group B CY26	Prime * Group A CY26	Prime * Group B CY26
Durable medical equipment	20% (IN); 25% (OON)	20% (IN); 25% (OON)	20%	20%.
Inpatient admission:
In-network	$250/day up to 25% of hospital charges, plus 20% of sep. billed services	$231 per adm	$198 per adm	$198 per adm.
Out of network	‡ $1,306/day up to 25% of hosp. charges, plus 25% of sep. billed services	25%	$198 per adm	$198 per adm.
( printed page 50747)
Inpatient SNF/rehab facility	$250/day up to 25% of hospital charges, plus 20% of sep. billed services (IN); 25% (OON)	$66 per day (IN); lesser of $397 per day or 20% (OON)	$39 per day	$39 per day.
‡ 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

Legal Citation

Federal Register Citation

Use this for formal legal and research references to the published document.

90 FR 50745

Web Citation

Suggested Web Citation

Use this when citing the archival web version of the document.

“TRICARE; Calendar Year (CY) 2026 TRICARE Prime and TRICARE Select Out-of-Pocket Expenses,” thefederalregister.org (November 10, 2025), https://thefederalregister.org/documents/2025-19819/tricare-calendar-year-cy-2026-tricare-prime-and-tricare-select-out-of-pocket-expenses.