TRICARE Prime vs. Select: Deductibles, Copays, and Caps

Under TRICARE Prime, you pay no annual deductible and fixed-dollar copays for care routed through your primary care manager; under TRICARE Select, you pay an annual deductible first and then either fixed copays for network care or a percentage cost share for non-network care. That is the core of the TRICARE Prime vs. Select deductibles and cost sharing comparison. Prime costs less at the point of care but restricts you to referrals. Select costs more per visit but lets you see any TRICARE-authorized provider without one. Your specific numbers depend on two things the plans themselves don’t control: which cost group you fall into, and whether your sponsor is active duty or retired.

Why Your Group and Status Set the Numbers

Every beneficiary falls into Group A or Group B. If your sponsor first enlisted or was appointed before January 1, 2018, you’re in Group A. On or after that date, Group B.¹ The assignment is permanent and doesn’t change when the sponsor retires.

Sponsor status matters just as much. Active duty service members pay nothing out of pocket under Prime, and their family members pay nothing for most covered services under either plan aside from Select deductibles and copays.² Retirees and their dependents pay the heaviest costs under both plans. Every comparison below splits along those lines because the dollars do.

Deductibles: Prime Has None, Select Has Several

TRICARE Prime has no annual deductible when you use your primary care manager or a proper referral. Cost-sharing starts immediately at fixed copay amounts, with no threshold to clear.

TRICARE Select requires you to meet a deductible before cost-sharing begins, and the amount depends on group, status, pay grade, and whether the provider is in-network.

For active duty family members in 2026:³

E-4 and below, Group A: $50 individual / $100 family
E-4 and below, Group B: $66 individual / $132 family
E-5 and above, Group A: $150 individual / $300 family
E-5 and above, Group B: $198 individual / $397 family

For retirees and their family members:⁴

Group A, network: $150 individual / $300 family
Group B, network: $198 individual / $397 family
All retirees, non-network: $397 individual / $794 family

The non-network jump is the number to watch. A Group A retiree who goes out of network faces a deductible nearly triple the in-network amount. Staying in the network is the single easiest way to keep Select spending down.

Copays and Cost Shares

Under Prime

Active duty service members and their family members pay nothing for most Prime services. Retiree Prime copays for 2026 are flat dollar amounts:³

Specialty care visit: $39
Urgent care visit: $39
Emergency room visit: $79
Inpatient admission: $198 per admission

You know before you walk into the office what you’ll owe. Prime doesn’t distinguish network from non-network because all your care flows through the referral system.

Under Select

Select splits its cost-sharing in two. Network visits carry fixed copays. Non-network visits switch to a percentage of the TRICARE-allowable charge, applied after you’ve met your annual deductible.

Network copays for 2026, comparing Group A active duty family members and Group A retirees:³

Primary care: $28 / $38
Specialty care: $39 / $52
Urgent care: $28 / $38
Emergency room: $103 / $138

Group B numbers are sometimes lower per visit. Group B active duty family members pay $19 for primary care and $52 for the ER; Group B retirees pay $33 for primary care and $105 for the ER.³ The lower per-visit copay can be misleading, though, because Group B typically pays higher enrollment fees and deductibles that eat back the savings.

For non-network care under Select, active duty family members pay 20 percent of the allowable charge and retirees pay 25 percent, after the deductible.³ On a $5,000 procedure, that’s $1,000 or $1,250 out of pocket before balance billing enters the picture.

Non-participating providers (those who haven’t signed a TRICARE agreement) can legally bill you up to 15 percent above the allowable charge on top of your regular cost share.⁵ That cap applies inside the U.S. and its territories. Overseas, there may be no limit. Balance-billed amounts don’t count toward your catastrophic cap, so this money is purely extra. Confirm participation before you schedule non-emergency care.

Hospital Stays: Where the Gap Widens

Inpatient care is the setting where the two plans diverge the most.

A Prime retiree pays a flat $198 per admission regardless of length of stay. Select retirees face a formula that varies by group and network status:³

Group A retirees, network: $250 per day (or up to 25 percent of hospital charges, whichever is less), plus 20 percent of separately billed professional services
Group B retirees, network: $231 per admission
Group A active duty family members, network: $24.50 per day or $25 per admission, whichever is more
Group B active duty family members, network: $79 per admission

A three-day stay for a Group A retiree on Select can run $750 in facility fees alone, plus 20 percent of the surgeon’s and anesthesiologist’s charges. The same stay under Prime: $198 total. For anyone expecting significant medical use, that comparison alone can justify Prime’s higher enrollment fee.

The Prime Point-of-Service Trap

Prime enrollees who skip the referral process and seek non-emergency care on their own trigger the point-of-service option, which carries the steepest costs in the whole system. Active duty service members are exempt. Everyone else on Prime faces a separate $300 deductible ($600 family) followed by a 50 percent cost share of the allowable charge.⁶

Point-of-service charges don’t count toward your annual catastrophic cap, so there’s no ceiling on this spending.⁷ Fifty percent is worse than any standard Select rate. If you regularly want to see providers without going through a referral, Select is almost certainly the better plan for you. Point-of-service is a safety valve, not a routine pathway.

The Ceiling: Catastrophic Caps

The catastrophic cap is the annual limit on your out-of-pocket spending. Once you hit it, TRICARE covers 100 percent of the allowable amount for covered services for the rest of the calendar year. For 2026:⁷

Active duty families, Group A: $1,000 per family
Active duty families, Group B: $1,324 per family
Retirees, Group A (Prime): $3,000 per family
Retirees, Group A (Select): $4,381 per family
Retirees, Group B (Prime or Select): $4,635 per family

Enrollment fees, deductibles, and copays all count toward the cap. Point-of-service charges, balance billing above the allowable charge, non-covered services, and premiums for plans like TRICARE Reserve Select do not.⁷

For a Group A retiree, Prime’s $3,000 cap gets you to full coverage $1,381 sooner than Select’s $4,381 cap. If you expect to hit the ceiling in a given year, that’s another point in Prime’s favor.

Which Plan Costs Less for You

Prime tends to work out cheaper if you use a lot of care, especially inpatient care, and are comfortable getting referrals. The predictable copays, absence of a deductible, flat inpatient charge, and lower catastrophic cap all pull in the same direction.

Select tends to work out cheaper if you use little care, want to pick your own specialists, or live somewhere Prime networks are thin. You accept a deductible and higher per-visit costs in exchange for skipping the referral system. Just recognize what non-network care actually costs on Select: a percentage of every bill, plus a potentially larger deductible, plus possible balance billing.

One factor that isn’t a differentiator: preventive care and pharmacy costs are essentially the same under both plans. Preventive visits are $0 under Prime and Select alike for all beneficiary groups when you use network care.³ Pharmacy copays are identical across plans and beneficiary types, so your prescription bill won’t push you toward one plan or the other.⁸

When You Can Switch

You can change between Prime and Select during the annual open enrollment period, which typically runs in the fall. For coverage starting January 1, 2026, open enrollment closed on December 9, 2025.⁹

Outside open season you can only switch after a qualifying life event: a permanent change of station, marriage, birth of a child, retirement from active duty, and similar changes. A qualifying life event opens a 90-day window, with coverage starting on the date of the event.¹⁰ Retiring service members who don’t enroll in a plan within 90 days of retirement lose TRICARE coverage entirely. That’s the one deadline no beneficiary can afford to miss.

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TRICARE. Beneficiary Groups
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TRICARE. TRICARE Prime
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TRICARE. TRICARE 2026 Costs and Fees
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TRICARE. TRICARE 2026 Costs and Fees Preview
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TRICARE Newsroom. TRICARE-Allowable Charges and Balance Billing What You Need to Know
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TRICARE. Point-of-Service Option
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TRICARE. Catastrophic Cap
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TRICARE. Pharmacy Costs
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TRICARE Newsroom. TRICARE Open Season Ends Dec 9 Last Chance to Change Your Health Plan for 2026
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TRICARE. Qualifying Life Events