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TRICARE Handbook

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.

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

• Co-payment 5 percent less than TRICARE Standard;
• No balance billing;
• No enrollment fee;
• No deductible when using retail pharmacy network;
• No forms to file; and
• You may use also TRICARE Standard.

Disadvantages

• No Primary Care Manager;
• Provider choice is limited;
• Patient pays:
  • Deductible,
  • Co-payment.
• Nonavailability statement may be required for civilian inpatient care for areas surrounding MTFs; and
• Not universally available.

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TRICARE Handbook

TRICARE Standard is the new name for traditional CHAMPUS. Under this plan, you can see the authorized provider of your choice. (People who are happy with coverage from a current civilian provider often opt for this plan.) But having this flexibility means that care generally costs more.

Treatment may also be available at a military treatment facility, if space allows and after TRICARE Prime patients have been served. Furthermore, TRICARE Standard may be the only coverage available in some areas.

Who is Eligible for TRICARE Standard?

Anyone who is CHAMPUS eligible may use TRICARE Standard. (Active duty personnel are not CHAMPUS eligible and are automatically enrolled in TRICARE Prime).

Reserve Component family members are eligible for TRICARE Standard, if the Reserve Component member is ordered to active duty under 10 U.S.C. or 32 U.S.C. for more than 30 consecutive days or if the orders are for an indefinite period of time. (The RC member is entitled to the TRICARE Prime benefit as soon as he/she is activated.)

Advantages

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

Disadvantages

• No Primary Care Manager;
• Patient pays:
  • Deductible,
  • Copayment,
  • 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; and 
• Beneficiaries may have to do their own paperwork and file their own claims.