TRICARE Prime vs Select for ABA: 2026 Copays, Referrals and Catastrophic Caps

TRICARE covers ABA for autistic children through the Autism Care Demonstration (ACD), under both TRICARE Prime and TRICARE Select. The rules for getting ABA approved are almost the same in both plans. What differs is what you pay: enrollment fees, deductibles, the copayment for each day of therapy, and the yearly catastrophic cap. This guide compares those costs using TRICARE's 2026 figures, explains the one-copay-per-day rule, and shows how to estimate your family's yearly ABA cost. For the program rules themselves, see our TRICARE ACD guide.

How does TRICARE charge for ABA?

tricare.mil's ACD page (updated September 21, 2026) sets three cost rules:

• "You pay the copayment or cost-share for your TRICARE plan for all ABA services."
• "All ABA services rendered on one day will be subject to one copayment." A day with direct therapy, BCBA supervision and parent training is one copay, not three.
• These amounts count toward your calendar-year (January 1 to December 31) catastrophic cap, and "There aren't yearly or lifetime caps on the amount of ABA services TRICARE covers."

Which copay line applies? Humana Military, the TRICARE East contractor for Florida, says in its ABA provider FAQ that "ABA providers are considered outpatient specialty providers" for copay purposes. So the row to read in TRICARE's cost tables is the outpatient specialty care visit.

Which beneficiary group am I in?

TRICARE costs depend on two things: your sponsor's status (active duty or retired) and your group.

• Group A: the sponsor's initial enlistment or appointment was before January 1, 2018.
• Group B: the sponsor's initial enlistment or appointment was on or after January 1, 2018.

Active duty service members themselves have no out-of-pocket costs. The figures below are for family members.

What do Prime and Select cost for ABA in 2026?

These figures are from TRICARE's Health Plan Costs page, which says "All costs are for calendar year 2026" (page last updated September 24, 2026). Costs change each calendar year, so check the page again for 2027.

Medically retired sponsors, their families and survivors have different Group A rules (for example, a $3,000 Select catastrophic cap and frozen Prime enrollment fees). tricare.mil lists them separately.

Do Prime and Select handle ABA referrals differently?

Less than you might expect. TRICARE's ACD page says your child "must get a referral to the ACD and a pre-authorization for all ABA services. All TRICARE plans require this." TRICARE's referrals page (updated October 7, 2026) makes the point for Select directly: under TRICARE Select and the other non-Prime plans, "Only applied behavior analysis requires a referral."

One Prime caution: under Prime, if you see a non-network provider without a referral you are using the point-of-service option, which costs more. Because ABA always needs a referral and authorization, make sure your ABA provider is the one named in your authorization letter.

How do I estimate my family's ABA cost for the year?

Use three numbers: your copay per ABA day, roughly how many days a week your child has ABA, and your catastrophic cap. The worked examples below are illustrations only. Your real cost depends on your plan, your deductible, other care your family uses, and the hours TRICARE authorizes.

Example 1: retiree family, Select Group B, network provider

• Copay: $52 per ABA day (all ABA that day counts as one copay).
• Schedule: 4 ABA days a week, so about $208 a week in copays.
• Catastrophic cap: $4,635 per family. tricare.mil says enrollment fees count toward the cap, so a family paying the $1,191 Select family fee has $3,444 left. $3,444 divided by $52 is about 66 ABA days, or roughly 17 weeks at 4 days a week, if the family had no other costs.
• Once the family reaches the cap, TRICARE pays your portion of the allowable charge for covered services for the rest of the calendar year, and Prime and Select enrollees stop paying enrollment fees for that year.

Example 2: active duty family, Select Group A, network provider

• Copay: $39 per ABA day.
• Catastrophic cap: $1,000 per family, reached after about 26 ABA days of copays alone.
• Deductibles, pharmacy copays and other covered family care also count toward the same cap, so you may reach it sooner. Point-of-service charges and non-covered services do not count.

Example 3: active duty family, Prime, network provider

• Copay: $0 for network specialty care, so ABA itself adds no copays.

For the general math of deductibles and out-of-pocket limits, see real ABA cost math.

What about TRICARE Reserve Select, Retired Reserve and Young Adult?

Humana Military's FAQ lists these plans among those whose members can use the ACD. Their 2026 network specialty copays on tricare.mil are $33 for TRICARE Reserve Select (family catastrophic cap $1,324) and $52 for TRICARE Retired Reserve (cap $4,635). TRICARE Young Adult follows Group B costs plus its own monthly premium. Monthly premiums for Reserve Select and Retired Reserve are on tricare.mil. Our guide to TRICARE ABA for retirees, Guard and Reserve families covers eligibility.

Prime or Select: a decision checklist

• Is Prime available where you live in Florida? Ask Humana Military (1-800-444-5445).
• Which group are you in, and are you active duty or retired? That sets your copay and cap.
• Is your preferred ABA provider in the TRICARE network? Network copays are fixed amounts; non-network Select care is a percentage.
• How many ABA days a week does your child's plan call for? More days means you reach the cap sooner.
• Does your family use a lot of other care? It all counts toward one family cap.
• For retirees: compare the enrollment fee plus the cap, not just the copay.
• When can you switch? Generally during TRICARE Open Season or after a qualifying life event, such as retiring or moving. Check tricare.mil/openseason for dates.

Whichever plan you choose, ABA still needs a referral, pre-authorization, six-month reauthorizations and a new referral every two years. See renewing your referral without a gap.

Can a provider waive my TRICARE copay?

No. Florida law treats a provider's general business practice of not collecting copays or deductibles as insurance fraud (Fla. Stat. 817.234(7)(a)), so a provider should not offer to skip them. If cost is a barrier, ask the provider about payment plans or hardship options and check how close you are to your catastrophic cap.

How Hope Center can help

Hope Center for Behavior Change is in network with TRICARE East (Humana Military). We offer a free benefits check, so you can see what your family is likely to pay before services begin. Our BCBAs write each treatment plan, our clinical director reviews every plan before it goes to TRICARE, and we provide weekly parent training. Learn more on our TRICARE ABA page, request a free consultation or call 561-337-8865.