Using Assistive Technology? Click here to change your profile Skip Navigation Skip to Footer

TRICARE Standard and Extra


TRICARE Standard and Extra costs vary depending on the sponsor's military status (active duty vs. retired).

Annual Outpatient Deductible
You must meet the annual outpatient deducible each fiscal year (October 1 - September 30) before cost-sharing begins:

  • Active duty sponsor
    • Rank E4 and below: $50 per individual/$100 per family
    • Rank E5 and above: $150 per individual/$300 per family
  • All others: $150 per individual/$300 per family

The annual outpatient deductible is waived for family members of National Guard/Reserve members who are called to active duty for more than 30 days in support of a contingency operation.

Cost Shares
You're responsible to pay a cost share based on the type of care and type of provider (network vs. non-network). Non-network providers may charge up to 15% above the TRICARE allowable charge. You are also responsible for these extra charges.

Costs effective October 1, 2011

Type of Care

Cost Share

Active Duty Family Members*

All Others

Ambulance Services

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Ambulatory (same day) Surgery

$25 per visit

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Behavioral Health

Outpatient:

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Hospitalization:

$20 per day ($25 minimum)

Outpatient:

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Hospitalization:

Network Provider:
20% of the total charge, plus 20% cost-share for separately billed services

Non-network Provider:

High-Volume Hospital- 25% of the hospital-specific per diem

Low-Volume Hospital- $208 per day or 25% of the billed charges, whichever is less

Clinical Preventive Services

$0 for colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6. For all other preventive services:

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Emergency Room Visit

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Home Health Care

$0

$0

Hospice Care

$0

$0

Hospitalization

$17.05 per day ($25 minumum)

Network Provider:
$250 per day or 25% of billed charges for institutional services, whichever is less, plus 20% cost-share for separately billed services

Non-network Provider:
$708 per day or 25% of billed charges for institutional services, whichever is less, plus 25% cost-share for separately billed services

Lab & X-Ray Services

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Maternity Care

Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee.

  • $17.05 per day ($25 charge)

Office visits for delivery planned in a TRICARE-authorized birthing center.

  • $25 per visit

Office visits for delivery planned at home or another setting.

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee.

Network Provider:
$250 per day or 25% of billed charges for institutional services, whichever is less, plus 20% cost-share for separately billed services

Non-network Provider:
$708 per day or 25% of billed charges for institutional services, whichever is less, plus 25% cost-share for separately billed services

Office visits for delivery planned in a TRICARE-authorized birthing center, at home or another setting.

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Newborn Care

$0 as the newborn is deemed enrolled in TRICARE Prime for up to the first 60 days.

Network Provider:
The lower of the number of hospital days minus 3 multiplied by $250 or 25% of the negotiated rate for institutional services, plus 20% for separately billed professional charges.

Non-network Provider:
The lower of the number of hospital days minus 3 multiplied by DRG per diem copayment or 25% of billed charges for institutional services, plus 25% for separately billed professional charges.

Outpatient Visit

Network Provider:
15% of the negotiated rate

Non-network Provider:
20% of the allowable charge

Network Provider:
20% of the negotiated rate

Non-network Provider:
25% of the allowable charge

Skilled Nursing Care

$17.05 per day ($25 minimum)

Network Provider:
$250 per day or 20% for institutional services, whichever is less, plus 20% for separately billed professional charges

Non-network Provider:
25% for institutional services, plus 25% cost share for separately billed professional charges

*Includes family members of activated National Guard/Reserve Members.

Last Modified:May 30, 2012

Text Size Increase text size Increase text size   Printer Icon/Text Only Print

Contact

Look up a toll-free number.