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TRICARE Extra Coverage

Doctor greets a patient with a handshake.

TRICARE Extra is a health insurance program that requires you to choose your provider from within the TRICARE network, the costs are less than TRICARE Standard, which allows you to choose your own provider. The program covers, dependents, retirees, and survivors. You don't need to enroll in the program, if you are listed as a dependent in DEERS you are eligible.

Choosing a Provider

To choose a provider, you should visit the TRICARE website and use their Doctor locator tool to find a network provider in your area. Once you find one, you are responsible for making your own appointment.

Cost

While TRICARE Extra doesn't have montly premiums, or enrollment fees, there is an annual deductible (the amount you must pay out-of-pocket before coverage begins), and cost-sharing or copay (the amount you must pay the Doctor for the service), there is also an annual "catastrophic cap" which limits how much a family must pay out of pocket for services. These amounts are different depending on the sponsor's status.

Active Duty and Guard/Reserve Sponsor

Annual Deductible: 

  • Sponsor Rank E4 and below: $50 per person, $100 per family
  • Sponsor Rank E5 and above: $150 per person, $300 per family
TRICARE Extra Cost-Share When Sponsor is Active Duty or Guard/Reserve
Service Cost
Ambulance Services 15% of negotiated fee
Ambulatory Surgery (Same Day) $25
Behavioral Health (Inpatient) $20 per day ($25 minimum charge)
Behavioral Health (Outpatient) 15% of negotiated fee
Clinical Preventive Services $0 for colorectal, breast, cervical and prostate cancer screenings;
immunizations; and well-child visits for children under age 6.

For all other preventive services:
15% of negotiated fee
DME, Prosthetic Devices, Medical Supplies 15% of negotiated fee
Emergency Services 15% of negotiated fee
Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care) $17.80 per day ($25 minimum charge)
Immunizations $0
Laboratory & X-ray 15% of negotiated fee
Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting) $17.80 per day ($25 minimum charge)

Note: This is one global fee for all of the maternity care and delivery.
Maternity (office visits for delivery planning in a TRICARE-authorized birthing center) $25
Maternity (office visits for delivery planned at home or other setting) 15% of negotiated fee
Newborn Care $17.80 per day ($25 minimum charge)
Outpatient Visit 15% of negotiated fee
Skilled Nursing (Inpatient) $17.80 per day ($25 minimum charge)

Only available in the U.S. and U.S. Territories.

 

Retirees, Their Families, and All Others

Annual deductible: $150 per person but not more than $300 per family.

TRICARE Extra Cost-Share For Retirees, Their Families and All Others
Service Cost
Ambulance Services 20% of negotiated fee
Ambulatory Surgery (Same Day) 20% of negotiated fee
Behavioral Health (Inpatient)

20% of the total charge plus 20% for separately billed services

Behavioral Health (Outpatient) 20% of negotiated fee
Clinical Preventive Services $0 for colorectal, breast, cervical and prostate cancer screenings;
immunizations; and well-child visits for children under age 6.

For all other preventive services:
20% of negotiated fee
DME, Prosthetic Devices, Medical Supplies 20% of negotiated fee
Emergency Services 25% of allowable charge
Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care) $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges
Immunizations $0
Laboratory & X-ray 20% of negotiated fee
Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting) $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges
Note: This is one global fee for all of the maternity care and delivery.
Maternity (office visits for delivery planning in a TRICARE-authorized birthing center) 20% of negotiated fee
Maternity (office visits for delivery planned at home or other setting) 20% of negotiated fee
Newborn Care The lower of the number of hospital days minus 3 multipled by$250 or 25% of billed charges for institutional services, plus 20% for separately billed professional charges.
Outpatient Visit 20% of negotiated fee
Skilled Nursing (Inpatient) 25% for institutional services, plus 25% cost share for separately billed professional charges.

Only available in the U.S. and U.S. Territories.

 

Limits on What You Pay

A "catastrophic cap" is the annual upper limit a family will have to pay for TRICARE Extra covered services in any fiscal year. The catastrophic cap for families of active duty service members is $1,000. All others have a catastrophic cap of $3,000.

Related Topics

TRICARE

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