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.
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.