TIP:
Saving your receipts can save you both money and headaches. Some health care expenses can be deducted from your taxes, and you never know when you may be incorrectly double billed.

Each of the three TRICARE options are designed to fit the needs of the individual beneficiary. Understanding the following factors will assist you in determining if TRICARE Extra is your best choice:

With this Extra, you don't have to enroll or pay an annual fee. You do have to satisfy an annual deductible for outpatient care, just as you do under TRICARE Standard. The deductible and cost sharing work the same way for TRICARE Extra. In the TRICARE Extra program, when you receive care from a TRICARE Extra network provider, you get a discount on cost sharing, and you don't have to file your own claims. You don't enroll and may use TRICARE Extra on a case-by-case basis just by using the network providers. TRICARE Extra is not available overseas or to active duty service members.

Advantages

  • Co-payment 5% less than TRICARE Standard
  • No balance billing
  • No enrollment fee
  • No deductible when using retail pharmacy network
  • No forms to file
  • You may use also TRICARE Standard

Disadvantages

  • No Primary Care Manager

  • Provider choice is limited
  • Patient pays Deductible and Co-payment
  • Non availability statement may be required for civilian inpatient care for areas surrounding MTF's
  • Not universally available

TRICARE Cost Comparison at a Glance

The following tables provide examples of cost-shares or co-payments for families who use civilian providers and facilities under each of the three TRICARE options. The listed fees are subject to change.

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Active Duty Family Members:
TRICARE
Prime
TRICARE
Extra
TRICARE
Standard
Annual Deductible
None
$150/individual or $300/family for E-5 & above; $50/$100 for E-4 & below
$150/individual or $300/family for E-5 & above; $50/100 E-4 below
Annual Enrollment Fee
None
None
None
Civilian Outpatient Visit
No cost
15% of negotiated fee
20% of allowed charges for covered service
Civilian Inpatient Admission
No cost
Greater of $25 or $13.90/day
Greater of $25 or $13.90/day
Civilian Inpatient Mental Health
No cost
$20/day
$20/day
Civilian Inpatient Skilled Nursing Facility Care
$0 per diem charge per admission

No separate co-payment/cost-share for separately billed professional charges
$11/day
($25 minimum) Charge per admission
$11/day
($25 minimum) Charge per admission

 

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Retirees (under 65), Their Family Members, and Others
TRICARE
Prime
TRICARE
Extra
TRICARE
Standard
Annual Deductible
None
$150/individual or
$300/family
$150/individual or
$300/family
Annual Enrollment Fee
$230/individual $460/family
None
None
Civilian Co-pays
 
20% of negotiated
fee
25% of allowed charges for covered service

Outpatient
Emergency Care
Mental Health Visit
$12 
$30 
$25 
  $17 (group visit)
 
 
Civilian Inpatient
Cost Share
$11/day
($25 minimum) Charge per admission
Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated professional fees
Lesser of $512/day or 25% of billed charges plus 25% of allowed professional fees
Civilian Inpatient Skilled Nursing Facility Care
$11/day
($25 minimum) charge per admission
$250 per diem co-payment or 20% cost-share of total charges, whichever is less, institutional services, plus 20% cost-share of separately billed professional charges
25% cost-share of allowed charges for institutional services, plus 25% cost-share of allowable for separately billed professional charges.
Civilian Inpatient Mental Health
$40 per day
20% of institutional & negotiated professional fees
Lesser of $169/day or 25% of allowable fees

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SUMMARY -- Tricare Extra

  • Choose any doctor in Tricare Extra network
  • Less expensive than Tricare Standard
  • Still may be expensive
  • Enrollment not required
  • Can still seek space-available care in military hospital, but at low priority
Helpful Hint:
  • Sponsors should ensure their family members have up-to-date uniformed services identification cards, and that they are properly enrolled in the Defense Enrollment Eligibility Reporting System (DEERS).