TRICARE Standard Email This Story Print This Story

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.)

Click Here to see how Standard differs from Prime.

See Prime, for more information on who is eligible 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.

Standard's Advantages

  • Broadest choice of providers
  • Widely available
  • No enrollment fee
  • You may also use TRICARE Extra

 

Standard's Disadvantages
  • No Primary Care Manager
  • Patient pays Deductible and Co-payment
  • 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

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.

TRICARE Links
TRICARE Overview
TRICARE Prime
TRICARE Standard
TRICARE Extra
 
TRICARE & American Association of Pediatrics
TRICARE & DEERS (Defense Enrollment Eligibility Reporting System)
TRICARE & WIC (Women, Infants, and Children)
TRICARE Claims How to file a TRICARE Claim
TRICARE Continued Health Care Benefits
TRICARE Dental
TRICARE Eligibility
TRICARE Family-Centered Care includes Obstetric Care
TRICARE for Life
TRICARE for Life and Medicare
TRICARE Generic Pharmacy Brochure
TRICARE Information - Puerto Rico
TRICARE Overseas
TRICARE Pharmacy
TRICARE Prime Enrollment Info
TRICARE Prime Remote
TRICARE Prime Travel and Non-Medical Attendant (NMA)
TRICARE Providers
TRICARE Reserve Select
TRICARE Standard vs Prime






Recent Items
» Basic Training - The Journey for every Soldier
» Buffalo Bills Military Discount
» GlassesUSA
» 2009 U.S. Army Soldier Show
» 2009 Army Concert Tour
Most Popular Items
» Army Pay Overview
» Can I Join the Army with a Felony?
» Military Occupation Specialties (MOS)
» I Want Out!
» U.S. Army Current Uniforms



This website is not affiliated, endorsed, authorized, or associated in any way with any government, military or country.
:::::