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: Non-network Provider: |
Network Provider: Non-network Provider: |
Ambulatory (same day) Surgery |
$25 per visit |
Network Provider: Non-network Provider: |
Behavioral Health |
Outpatient: Network Provider: Non-network Provider: Hospitalization: $20 per day ($25 minimum) |
Outpatient: Network Provider: Non-network Provider: Hospitalization: Network Provider: 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: Non-network Provider: |
Network Provider: Non-network Provider: |
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies |
Network Provider: Non-network Provider: |
Network Provider: Non-network Provider: |
Emergency Room Visit |
Network Provider: Non-network Provider: |
Network Provider: Non-network Provider: |
Home Health Care |
$0 |
$0 |
Hospice Care |
$0 |
$0 |
Hospitalization |
$17.05 per day ($25 minumum) |
Network Provider: Non-network Provider: |
Lab & X-Ray Services |
Network Provider: Non-network Provider: |
Network Provider: Non-network Provider: |
Maternity Care |
Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee.
Office visits for delivery planned in a TRICARE-authorized birthing center.
Office visits for delivery planned at home or another setting. Network Provider: Non-network Provider: |
Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee. Network Provider: Non-network Provider: Office visits for delivery planned in a TRICARE-authorized birthing center, at home or another setting. Network Provider: Non-network Provider: |
Newborn Care |
$0 as the newborn is deemed enrolled in TRICARE Prime for up to the first 60 days. |
Network Provider: Non-network Provider: |
Outpatient Visit |
Network Provider: Non-network Provider: |
Network Provider: Non-network Provider: |
Skilled Nursing Care |
$17.05 per day ($25 minimum) |
Network Provider: Non-network Provider: |
*Includes family members of activated National Guard/Reserve Members.
Last Modified:May 30, 2012
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