|
|
|
|
|
| |
TRICARE: Summary of Beneficiary Costs
|
 |
 |
|
Previous Page Table of Contents Next Page
|
|
|
TRICARE Standard and TRICARE Extra
Annual Outpatient Deductible
TRICARE Standard and TRICARE Extra Health Care Costs |
|
|
| |
TRICARE Standard and TRICARE Extra |
|
This section highlights your costs when using TRICARE Standard and TRICARE Extra. Remember, TRICARE Standard and TRICARE Extra can be used interchangeably and the option you use determines your out-of-pocket expense. If you have additional questions, contact Humana Military. |
| |
Back to Top
|
|
Annual Outpatient Deductible |
|
|
When using TRICARE Standard and TRICARE Extra, you are required to meet an annual deductible each fiscal year for outpatient services before cost-sharing begins. The annual deductible varies based on your beneficiary category and type of coverage (individual or family).
Note: ADSMs may not use TRICARE Standard and TRICARE Extra.
|
|
Beneficiary Category
|
Outpatient Deductible
|
Active Duty Family Members
(sponsor rank E-4 and below) |
- $50/Individual
- $100/Family
|
Active Duty Family Members
(sponsor rank E-5 and above) |
- $150/Individual
- $300/Family
|
| Retired Service Members, their Families and All Others |
- $150/Individual
- $300/Family
|
| Family Members of National Guard and Reserve Activated in Support of a Contingency Operation (OEF, OIF, Noble Eagle) |
$0; Deductibles waived as part of the TRICARE Reserve Family Demonstration Project
|
|
|
|
Back to Top
|
|
TRICARE Standard and TRICARE Extra Health Care Costs |
|
The costs listed are for care received in civilian facilities, are effective for fiscal year 2008 (October 1, 2007–September 30, 2008), and are subject to change each year on October 1. |
|
| Type of Care |
TRICARE Standard 2 |
TRICARE Extra |
Outpatient
Visit
(including behavioral health care) |
ADFMs:
20% after the annual deductible is met
Retirees, Their Families and All Others:
25% after the annual deductible is met
|
ADFMs:
15% after the annual deductible is met
Retirees, Their Families and All Others:
20% after the annual deductible is met
|
| DME, Prosthetic Devices, and Medical Supplies |
ADFMs:
20% after the annual deductible is met
Retirees, Their Families, and All Others:
25% after the annual deductible is met |
ADFMs:
15% after the annual deductible is met
Retirees, Their Families, and All Others:
20% after the annual deductible is met |
| Hospitalization |
ADFMs:
$15.15 per day ($25 minimum charge)2
Retirees, Their Families and All Others:
$535 per day or 25% for institutional services, whichever is less, plus 25% for separately billed services
|
ADFMs:
$15.15 per day ($25 minimum charge)2
Retirees, Their Families and All Others:
$250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed services
|
Inpatient
Skilled
Nursing |
ADFMs:
$15.15 per day ($25 minimum charge)2
Retirees, Their Families and All Others:
25% for institutional services plus 25% cost-share for separately billed services
|
ADFMs:
$15.15 per day ($25 minimum charge)2
Retirees, Their Families and All Others:
$250 per day or 20% for institutional services, whichever is less, plus 20% for separately billed services
|
| Inpatient Behavioral Health |
ADFMs:
$20 per day ($25 minimum charge)1
Retirees, Their Families and All Others:
- High-volume hospitals—25% hospital specific per diem, plus 25% for separately billed professional services
- Low-volume hospitals—$187 per day or 25% of the billed charges, whichever is less, plus 25% for separately billed services
|
ADFMs:
$20 per day ($25 minimum charge)1
Retirees, Their Families and All Others:
20% of total charge, plus 20% for separately billed services
|
|
| |
|
|
1. The cost for inpatient care provided at a military treatment facility is $15.15 per day for ADFMs and retiree family memebers.
2. Example: If your hospital stay lasts one day, your charge for the stay will be $25. If your hospital stay lasts more than one day, your charge will be $15.15 ( or $20 for inpatient behavioral health) multiplied by the number of days of your stay.
|
| |
Back to Top
|
|
|
Last Reviewed: February 15, 2008
|
|
|
