TRICARE Standard offers great flexibility to its beneficiaries. If you want to make the most of this plan, it’s important to know how Standard differs from Extra and when you use one or the other.
Network vs. Non-Network Providers
The key distinction between the two is the type of provider you see:
- When you see a TRICARE-authorized non-network provider, you use Standard.
- When you see a TRICARE-authorized, network provider, you use Extra.
When you see a non-network provider – that is, a provider who is authorized yet not part of the TRICARE network – you have higher cost shares, also called copays, and may have to file your own claims. When you see a network provider, your copays are lower and the provider files claims for you.
This means that Extra is the least expensive option, but you may not have the freedom to see the provider you want.
If you are eligible for TRICARE Standard and Extra, you can use them interchangeably whenever you like.
Participating vs. Non-Participating Providers
When you use TRICARE Standard, you may see either a participating or a non-participating provider. It is more cost-effective to see the former.
Participating non-network providers have agreed to bill TRICARE directly and to accept the TRICARE allowable charges as full payment for their services. Non-participating, non-network providers have not agreed to this; further, they are allowed to charge up to 15% above the TRICARE allowable amount. You will be fully responsible for these extra charges; TRICARE cannot share in them.
With a non-participating provider, you may also need to pay upfront out-of-pocket and seek reimbursement from TRICARE later. Even if you do, TRICARE will not pay you more than its allowable amount for the claim.