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TRICARE Standard Coverage

Capt. Michelle Gauthier, 52nd Medical Operations Squadron certified registered nurse anesthetist at Spangdahlem Air Base, Germany, injects medication into an IV during a scheduled surgery. (US Air Force/Senior Airman Eydie Sakura)
Capt. Michelle Gauthier, 52nd Medical Operations Squadron certified registered nurse anesthetist at Spangdahlem Air Base, Germany, injects medication into an IV during a scheduled surgery. (US Air Force/Senior Airman Eydie Sakura)

TRICARE Standard is a health insurance program that allows you to choose your own provider, however the costs may be more than TRICARE Extra, which requires you to choose from TRICARE network providers. 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 Standard 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

Non-network providers may charge up to 15% more than the TRICARE allowable charge, TRICARE will pay this additional charge:

  • if the sponsor is activated in support of a contingency operation for more than 30 days
  • during the pe-activated and active periods for Guard & Reserve Sponsored dependents
  • when covered by TAMP upon deactivation

These costs are for in-network services. For non-networs services see the TRICARE website.

TRICARE Standard Cost-Share When Sponsor is Active Duty or Guard/Reserve
Service Cost
Ambulance Services 15% of allowable charge
Ambulatory Surgery (Same Day) $25
Mental Health (Inpatient) $18.20 per day ($25 minimum charge)
Mental Health (Outpatient) 15% of allowable charge
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 allowable charge
DME, Prosthetic Devices, Medical Supplies 15% of allowable charge
Emergency Services 15% of allowable charge
Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care) $17.80 per day ($25 minimum charge)
Immunizations $0
Laboratory & X-ray 20% of allowable charge
Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting) $18.20 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 allowable charge
Newborn Care $18.20 per day ($25 minimum charge)
Outpatient Visit 15% of allowable charge
Skilled Nursing (Inpatient) $18.20 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 Standard Cost-Share For Retirees, Their Families and All Others
Service Cost
Ambulance Services 20% of allowable charge
Ambulatory Surgery (Same Day) 20% of allowable charge
Mental Health (Inpatient)

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

Mental 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 allowable charge
DME, Prosthetic Devices, Medical Supplies 20% of allowable charge
Emergency Services 20% of allowable charge
Home Health Care $0
Hospice Care $0
Hospitalization (Inpatient Care)

Network: $250/day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges

Non-network: $848/day day or 25% for institutional services, whichever is less, plus 25% for separately billed professional charges

Immunizations $0
Laboratory & X-ray 20% of allowable charge
Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting)

Network: $250 per day or 25% for institutional services, whichever is less, plus 20% for separately billed professional charges.

Non-network: $848 per day or 25% for institutional services, whichever is less, plus 25% 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 allowable charge
Newborn Care Network: 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 allowable charge
Skilled Nursing (Inpatient) $250 per day or 25% for institutional services (whichever is less), 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 Standard-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 Insurance

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