Under this option, you will choose a doctor, hospital,
or other medical provider listed in the TRICARE Provider Directory.
If you need assistance, call the Health Care Finder (HCF)
at your nearest TRICARE Service Center.
With this option, you don’t have to enroll or pay an annual
fee. You do have to satisfy an annual deductible for outpatient
care, just as you do under TRICARE Standard. The deductible
and cost sharing work the same way for TRICARE Extra. In the
TRICARE Extra program, when you receive care from a TRICARE
Extra network provider, you get a discount on cost sharing,
and you don’t have to file your own claims. You don’t enroll
and may use TRICARE Extra on a case-by-case basis just by
using the network providers. TRICARE Extra is not available
overseas or to active duty service members.
Who is Eligible for TRICARE Extra?
Anyone who is CHAMPUS eligible may use TRICARE Extra. (Active
duty personnel are not CHAMPUS eligible and are enrolled in
TRICARE Prime).
Advantages
- Copayment 5% less than TRICARE
Standard - No balance billing
- No enrollment fee
- No deductible when using retail
pharmacy network - No forms to file
- You may use also TRICARE Standard
Disadvantages
- No Primary Care Manager
- Provider choice is limited
- Patient pays Deductible and Copayment
- Nonavailability statement may
be required for civilian inpatient care for areas surrounding
MTFs - Not universally available
Summary — Tricare Extra
- Choose any doctor in Tricare
Extra network - Less expensive than Tricare Standard
- Still may be expensive
- Enrollment not required
- Can still seek space-available
care in military hospital, but at low priority
TRICARE Extra summarized:
- Extra can be used by any TRICARE-eligible beneficiary,
who is not active duty, not otherwise enrolled in Prime,
and not eligible for TRICARE for Life. - Extra goes into effect whenever a Standard beneficiary
chooses to make an appointment with a TRICARE network provider.Extra, like Standard, requires no enrollment and involves
no enrollment fee. - Extra is essentially an option for TRICARE Standard beneficiaries
who want to save on out-of-pocket expenses by making an
appointment with a TRICARE Prime network provider (doctor,
nurse practitioner, lab, etc.). - The appointment with the in-network provider will cost
5% less than it would with a doctor who is a TRICARE authorized
or participating provider. - Also, the Extra option-user can expect that the network
provider will file all claims forms for him. (The Standard
beneficiary might have claims filed for him, but the non-network
provider can decide to file on his behalf or not, on a case
by case basis.) - When using the Extra option, the Standard beneficiary
must meet the same requirements to satisfy a deductible
and pay a cost share for treatment. - Under TRICARE Extra, because there is no enrollment, there
is no Extra identification card. Your valid uniformed services
ID card serves as proof of your eligibility to receive health
care coverage from any TRICARE Prime provider. - Your uniformed services 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 and it should
always be kept current-that is, you should check the expiration
date and have it renewed before it expires, and you should
make sure that all your personal information is correct
and up to date in the Defense Enrollment Eligibility Reporting
System (DEERS).
