TRICARE Standard and TRICARE Extra

When using TRICARE Standard, TRICARE Extra, TRS, and TRR you are responsible, under law, to pay an annual deductible and cost-shares associated with your care. The law prohibits health care providers from waiving the deductible or cost-shares and requires providers to make reasonable efforts to collect these amounts. Providers who offer to waive deductibles and cost-shares, or who advertise that they will do so, can be suspended or excluded as TRICARE-authorized providers.
           

Nonparticipating providers may charge up to 15 percent above the TRICARE-allowable charge. This amount is your responsibility and will not be reimbursed by TRICARE. Participating providers are prohibited from balance billing—billing you for any amount in excess of the TRICARE-allowable charge, less any applicable cost-share you pay. Once a participating provider marks “yes” on the claim form for that service, he or she cannot later revoke or cancel that decision. Participating providers who attempt to fraudulently collect higher payments are in violation of the participation agreement. Note: Non-network providers may choose to participate on a claim-by-claim basis.
        

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 or TRICARE Extra.