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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.

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

ADFMs (sponsor rank E-4 and below)

$50/Individual $100/Family 

ADFMs (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

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 Standard1

TRICARE Extra1

Outpatient Visit
(including behavioral
health care)

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

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:
$15.15 per day ($25 minimum charge)2

Retirees, Their Families, & 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, & 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, & All Others:
25% for institutional services, plus 25% for separately billed services
ADFMs:
$15.15 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

Inpatient Behavioral Health

ADFMs:
$20 per day ($25 minimum charge)2

Retirees, Their Families, & 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)2

Retirees, Their Families, & 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 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 $15.15 (or $20 for inpatient behavioral health) multiplied by the number of days of your stay.

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Last Reviewed: July 11, 2008