TRICARE Standard & TRICARE Extra Health Care Costs

The costs listed are for care received in civilian facilities. These costs are effective for fiscal year 2010 (October 1, 2009–September 30, 2010) and are subject to change each year on October 1.

Type of Care	TRICARE Standard1	TRICARE Extra1
Outpatient Visits	ADFMs: 20% after the annual deductible is met Retirees, Their Families, & All Others: 25% after the annual deductible is met	ADFMs: 15% after the annual deductible is met Retirees, Their Families, & All Others: 20% after the annual deductible is met
Clinical Preventive Services	ADFMs: 20% after the annual deductible is met Retirees, Their Families, & All Others: 25% after the annual deductible is met	ADFMs: 20% after the annual deductible is met Retirees, Their Families, & All Others: 25% after the annual deductible is met
DME, Prosthetic Devices, and Medical Supplies	ADFMs: 20% after the annual deductible is met Retirees, Their Families, & All Others: 25% after the annual deductible is met	ADFMs: 15% after the annual deductible is met Retirees, Their Families, & All Others: 20% after the annual deductible is met
Hospitalization	ADFMs: $16.30 per day ($25 minimum charge)2 Retirees, Their Families, & All Others: $645 per day or 25% for institutional services, whichever is less, plus 25% for separately billed services	ADFMs: $16.30 per day ($25 minimum charge)2 Retirees, Their Families, & All Others: $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed services
Emergency Services	ADFMs: 20% after the annual deductible is met Retirees, Their Families, & All Others: 25% after the annual deductible is met	ADFMs: 15% after the annual deductible is met Retirees, Their Families, & All Others: 20% after the annual deductible is met
Outpatient Behavioral Health	ADFMs: 20% after the annual deductible is met Retirees, Their Families, & All Others: 25% after the annual deductible is met	ADFMs: 15% after the annual deductible is met Retirees, Their Families, & All Others: 20% after the annual deductible is met
Inpatient Behavioral Health	ADFMs: $20 per day ($25 minimum charge)2 Retirees, Their Families, & All Others: High-volume Hospitals—25% of the hospital-specific per diem Low-volume Hospitals—$197 per day or 25% of the billed charges, whichever is less, plus 25% for separately billed services	ADFMs: $20 per day ($25 minimum charge)2 Retirees, Their Families, & All Others: 20% of total charge, plus 20% for separately billed services
Inpatient Skilled Nursing	ADFMs: $15.65 per day ($25 minimum charge)2 Retirees, Their Families, & All Others: 25% for institutional services, plus 25% for separately billed services	ADFMs: $15.65 per day ($25 minimum charge)2 Retirees, Their Families, & All Others: $250 per day or 20% for institutional services, plus 20% for separately billed services

¹ The cost for inpatient care provided at a military treatment facility is $15.65 per day for ADFMs and retiree family members.
 
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 $15.65 (or $20 for inpatient behavioral health) multiplied by the number of days of your stay.