TRICARE Standard is the basic TRICARE health care program
for people not enrolled in TRICARE Prime. (Active duty service
members are enrolled in Prime, and many other beneficiaries
choose to enroll.)
Standard is a fee-for-service plan that gives beneficiaries
the option to see any TRICARE-certified/authorized provider
(doctor, nurse-practitioner, lab, clinic, etc.). Standard
offers the greatest flexibility in choosing a provider, but
it will also involve greater out-of-pocket expenses for you,
the patient.
Standard requires that you satisfy a yearly deductible before
TRICARE payments begin, and you will be required to pay co-payments
or cost shares for outpatient care, medications, and inpatient
care. See What is required of a Standard beneficiary.
Patient pays balance if bill
exceeds allowable charge and provider is non-participating
(up to 15% additional)
Nonavailability statement may
be required for civilian inpatient care for areas surrounding
MTFs
Beneficiaries may have to do
their own paperwork and file their own claims
TRICARE
Standard costs beneficiaries:
Family Members of Active
Duty Service Members
Retirees, Their Family
Members and Others
Annual Deductible
$150 per individual or
$300 per family for E-5 and above; $50 per individual
or $100 per family for E-4 and below.
$150 per individual or
$300 per family
Cost Share
(outpatient visits, emergency
care and mental health visits)
20 percent of allowable
charges
25 percent of allowable
charges
Civilian Inpatient Cost
Share
Greater of $25 or $13.90*
per day
Lesser of $512* per day
or 25 percent of billed charges plus 25 percent of
allowed separately billedprofessional fees
Civilian Inpatient Mental
Health
$20 per day
Lesser of $169* per day
or 25 percent of allowable fees plus 25 percent of
allowed separately billed professional fees
How to get Standard coverage
A person who is properly registered in the Defense Enrollment
Eligibility Reporting System (DEERS)
is automatically covered by TRICARE Standard. You do not need
to enroll for Standard coverage, nor take any other action;
if you are eligible for TRICARE health care coverage, you
are automatically covered under TRICARE Standard.
Standard is not available to active duty service members,
who are covered by TRICARE Prime, nor to dependent parents
and parents-in-law. See How Standard differs from Prime.
TRICARE Extra is a Standard option that allows the beneficiary
to save on cost shares.
How to prove/verify that you have Standard coverage
Your valid uniformed services ID card serves as proof of your
eligibility to receive health care coverage under TRICARE
Standard. Your ID card is, in effect, your insurance card,
and you should have it with you whenever you seek medical
care. It is your proof of eligibility.
TRICARE delivers health care services, but it does not determine
who is or is not eligible for the benefit—the uniformed services
do that. Eligibility is decided by the services (at the personnel
office or ID card issuing office), and eligibility is recorded
in the database of DEERS.
