One question that I hear a lot is "How much more will I pay if I move to Tricare Standard?" With all the challenges using Tricare Prime, Tricare Standard is looking more and more attractive to people. So, what are the major differences for active duty families?
(Please note: this is not meant to be a definitive guide to all things Tricare. Please refer to the Tricare website at www.Tricare.mil for the most up-to-date and thorough information.)
For most families, the major concern about switching to Tricare Standard is the cost. It is more expensive than Tricare Prime, but not as much as you might think.
Deductible
A military family has a $300 annual deductible when using Tricare Standard, with a lower $100 deductible for families whose sponsor is rank E-4 or lower. That means that they pay the full amount of the first $300 ($100) of all medical care in a new fiscal year. (The fiscal year runs from 1 October to 30 September of the following year.)
Cost-Shares
Under Tricare Standard, once you reach the $300 ($100) deductible, you will then pay cost-shares and co-pays for the next chunk of medical costs, including medical care and prescriptions. Here's a sample of those cost-shares and co-pays:
- Well-baby visits: $0
- Regular doctor's appointments: 15% of Tricare negotiated fee
- Immunizations: $0
- Out-patient behavioral health: 15% of Tricare negotiated fee
- Maternity care varies based upon situation
If you choose to go to non-network providers, they may charge more. You will then be responsible for a larger share of the cost.
Catastrophic Cap
One of the truly great parts about Tricare Standard coverage is that the catastrophic cap is just $1,000 (for fiscal year 2016.) This means that once you've spent $1,000, Tricare covers everything else - provided you use network providers. (Again, this article is for active duty families. Retirees have a different catastrophic cap.) Everything you spend applies to that $1,000: deductible, co-pays, and cost-shares.
Supplemental Insurance
There are many companies that offer supplemental insurance for Tricare Standard families. These plans cover a portion of the costs that fall between $300 ($100) and $1,000. You'll have to check the available plans and do the math for your family. For plans that charge per person, larger families will find that the cost of the supplement exceeds the Tricare Standard catastrophic cap.
The Bottom Line
The bottom line is that most families will pay no more than $1000 per year using Tricare Standard, unless they choose to use providers who are outside the network. Depending on your family size, a supplemental policy may mean that your total out of costs are even less. The only "catch" is if you use non-network providers.
Obviously, this is not a comprehensive list of all things Tricare, but a short synopsis to help you in the decision making process. Always use the Tricare.mil website for more complete information.
