MOAA’s TRICARE Toolkit provides insight and tips for navigating your TRICARE benefits. Have a question or suggestion for an upcoming column? Email beninfo@moaa.org. Read other TRICARE Toolkit columns at MOAA.org/tricaretoolkit.
In 2019, the Centers for Disease Control and Prevention reported that 5.9% of those age 64 and younger had at least one hospital stay in the past year. For those 65 and older, that rate climbed to 16.6%.
What does your plan cover?
Beneficiaries covered under TRICARE have copays delineated in the box below. TRICARE covers initial and subsequent hospital care when care is provided by an individual professional provider.
TRICARE Copayment Comparison by Plan and Status
- Prime In Network: $0 active duty copay; $188 retired copay (per admission)
- Prime Out of Network: Point of Service (POS) for active duty/retired
- Select In Network: $22.30 active duty copay (per day); $259 retired copay (per day) or up to 25% of hospital charges (whichever is less), plus 20% of separately billed charges
- Select Out of Network: $22.30 active duty copay (per day); $1,221 retired copay (per day) or up to 25% of hospital charges (whichever is less), plus 25% of separately billed charges
Medicare Part A Hospital and Skilled Nursing Facility Stay Costs
- 1-60 Hospital Days: Medicare pays 100% after deductible; TRICARE For Life pays $1,632 deductible; you pay $0 for covered services.
- 61-90 Hospital Days: Medicare pays all but $408 per day; TRICARE For Life pays $408 per day; you pay $0 for covered services.
- 91-150 Hospital Days: Medicare pays all but $816 per day; TRICARE For Life pays $816 per day; you pay $0 for covered services. NOTE: Lifetime reserve days (91-150) paid for by Medicare
- 151+ Hospital Days: Medicare pays nothing; TRICARE For Life pays as primary payer; you pay TRICARE cost shares.
- 1-20 Skilled Nursing Facility Days: Medicare pays 100%; TRICARE For Life pays nothing; you pay $0 for covered services.
- 21-100 SNF Days: Medicare pays all but $204 per day; TRICARE For Life pays $204 per day; you pay $0 for covered services.
- 101+ SNF Days: Medicare pays nothing; TRICARE For Life pays as primary payer; you pay TRICARE cost shares. NOTE: You must have pre-authorization from TRICARE For Life
Care includes: a semiprivate room (and, when medically necessary, special care units), nursing services, meals, drugs, anesthesia, laboratory tests, X-ray and other radiology services, medical supplies/appliances, and blood and blood products.
Transitioning to Medicare
Beneficiaries enrolled in Medicare Part A (hospital insurance), with TRICARE For Life (TFL), pay no fees for covered services up to 150 days of a hospital stay.
You must meet two conditions: You’re admitted to the hospital as an inpatient after an official doctor’s order, and the hospital accepts Medicare.
[PREMIUM AND LIFE MEMBER EXCLUSIVE: Transitioning Into Medicare and TRICARE For Life]
A benefit period begins the day you are hospitalized or enter a skilled nursing facility (SNF). It ends the day after you haven’t had any inpatient hospital care for 60 days in a row. If you are rehospitalized (or reenter an SNF) after 60 days, a new benefit period begins. The Medicare inpatient hospital deductible ($1,632 in 2024) applies for each benefit period. There is no limit to the number of benefit periods.
Lifetime reserve days (91-150 in the box above) are the 60 days Medicare pays for when you’re in a hospital, an SNF, or an inpatient rehabilitation facility for more than 90 days in a row. Once you use your 60 lifetime reserve days, you don’t get any extra days during your lifetime that Medicare will cover. For TFL beneficiaries, TRICARE becomes primary payer and you incur TRICARE cost shares.
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