Military Health Care For Active, Guard & Reserves, and Retirees

Military health care is among the best coverage available anywhere. It’s as close to no-cost health insurance as you’ll find, Perhaps the biggest problem with military health care is that, like most military insurance plans, it can be difficult to understand.

Here’s a handy guide on the basics of all your military health care options.

Military Health Care for Active Duty Personnel

Active-duty personnel and their family members are eligible for health care through Tricare, the military health care program.

The plan has two different programs:

• Tricare Prime
• Tricare Select

You can switch between the two programs during the Tricare open season.

Let’s break down the two plans.

Tricare Prime

As an active-duty member of the armed services, you’re automatically enrolled in Tricare Prime.

Tricare Prime coverage is also available for family members of active-duty uniformed service members; family members of uniformed service retirees; family members of service members who died while on active duty or during retirement and individuals who were voluntarily or involuntarily separated from a service member, such as by divorce.

It has fewer out-of-pocket costs than Tricare Select and offers fewer provider options. You’ll be assigned a primary care manager (PCM) who will be a military or network provider.

Your PCM will be your primary care provider and will refer you to specialists, work with your regional contract for referrals and authorizations, accept your co-payments and file your claims.

As an active-duty service member, you’ll pay nothing out-of-pocket. Your family members will also pay nothing unless they’re using a point-of-service option.

However, family members will pay if they get care without a referral or use a network pharmacy or Tricare Home Delivery. If a non-participating provider is used, your family members may pay up to 15% of the cost.

There is no required annual deductible unless a point-of-service option is used.

If so, outpatient deductibles are $300 for individuals and $600 for familes, according to Tricare. Cost shares are 50% of the allowable charge for outpatient services and hospitalziation.

Point-of-service and other fees may apply if you receive care without a referral.

Out-of-pocket costs are limited by a catastrophic cap. This includes yearly deductibles, co-payments, pharmacy co-payments and other costs based on allowed charges.
Program enrollment fees don’t apply toward the catastrophic cap. However, enrollment fees don’t apply to active-duty service members or their family members.

If you enrolled after Jan. 1, 2018, the enrollment fee is $289.08 per year if you are single, and $578.16 per year for a family. The annual enrollment fee is slightly lower if you enrolled in previous years.
Coverage begins when you submit your enrollment application to your regional contractor.

Tricare Select

Formerly two separate plans, Tricare Extra and Tricare Standard, the two were merged into Tricare Select.

The program is available for the following individuals:

• Active-duty family members (active-duty service members themselves are not eligible)
• Retired service members and their families
• Family members of activated Guard or Reserve members
• Non-activated Guard or Reserve members and their families who qualify under the Transitional Assistance Management Program (provides 180 days of premium-free transitional health care benefits after regular Tricare benefits end)
• Retired Guard or Reserve members at age 60 and their families
• Survivors
• Medal of Honor recipients and their families
• Qualified former spouses

Tricare Select requires that you use a Tricare authorized provider. Referrals are not required, but you may need prior authorization from your regional contractor for certain services.

On the cost side, you’ll pay an annual deductible for outpatient services, plus cost shares for covered services.

There’s a long list of copayments and cost shares listed on the Tricare Select cost page, but here’s a summary of the more significant ones an active-duty family could expect to pay:

• Enrollment fees: $0
• Deductible: E1 – E4 $50 to $52 per individual and $100 to $105 per family; E5 and higher, $150 to $158 per individual and $300 to $317 per family.
• Catastrophic cap: $1,000 to $1,058.
• Outpatient visit: $15 to $22 for primary; $26  to $34 for specialty; non-network, 20%
• Urgent care: $21 to 22 in-network; 20% non-network
• Emergency services:  $42 to 93 in-network; 20% non-network
• Laboratory and X-Ray: Free in-network;  20% non-network
• Ambulance service: $15 to $70 in-network, inpatient/non-network, 20%
• Immunizations: Free
• Pharmacy: free at military pharmacy; $10 generic home delivery, $29 brand name delivery; $13 generic retail in-network; non-network pharmacy prescriptions cost $33 or 20% of the total.

Once again, that’s just a summary. Be aware that there may also be variations from these charges based on the specifics of each plan level.

You can check out our Tricare Reference Guide for more.

Military Health Care for Guard and Reserves

Members of the Selected Reserve and their families can be covered under Tricare Reserve Select when they are not on active-duty orders, not covered under the Transitional Assistance Management Program, and not eligible to be enrolled in the Federal Employees Health Benefits Program (FEHB).

However, members in the Individual Ready Reserve, including Navy Reserve Volunteer Training units, do not qualify for Tricare Reserve Select.

If you do become activated, you’re eligible to go back on Tricare Prime.

Like Tricare Select, you must use a Tricare-authorized provider. There are fees involved with this program, which will be lower if you use an in-network provider rather than a non-network provider.

Fees involved include monthly premiums, an annual deductible and cost share (or percentage) for covered services

Once again, there’s a long list of co-payments and cost shares listed on the Tricare Reserve Select cost page, but here’s a summary of the more significant ones:

• Enrollment fees: $47.20 per month for the member only; $238.99 for the member and family
• Deductible: E1-E4 $52 per individual and $105 per family; E5 and higher, $157 per individual and $317 per family
• Catastrophic cap: $1,058
• Outpatient visit: $15 for primary, $26 for specialty; 20% non-network
• Urgent care: $21 in-network; 20% non-network
• Emergency services: $42 in-network;  20% non-network
• Laboratory and X-Ray: Free in-network, 20% non-network
• Ambulance service: $15 in-network; 20% non-network
• Mental health: $15-26 in-network; 20% non-network
• Hospitalization and maternity: $63 in-network; 20% non-network
• Hospice and home health care: $0
• Immunizations: $0
• Pharmacy: Free at military pharmacy; $10 generic home delivery, $29 brand name delivery; $13 generic retail in-network; non-network pharmacy prescriptions cost $33 or 20% of the total. 

Tricare for Federally Employed Reservists, National Guardsmen and Technicians

“Dual-status” military reserve and National Guard technicians can enroll in Tricare in 2030, according to the National Guard Association of the United States. Currently, reservists and guardsmen employed by the federal government must receive their health coverage through the Federal Employee Health Benefit Plan (FEHBP), which can be more expensive for individuals and may include different deductibles, copays and catastrophic caps.

In 2021, Federal employee health coverage (FEHBP) premiums cost members between $94.64 and $234.31 per month for individuals, compared to the Tricare Reserve Select monthly premiums, which cost members between $150 and $474 per month.

FEHBP cost members between $265.02 and $680.61 per month for families, compared to Tricare Reserve Select, which cost members between $300 and $948 per family.

Opening Tricare to dual-status service members may aid in continuity of care during deployments and mobilizations and improve retention rates, according to a May 2021 Defense report to the Congressional Armed Services Committee.

In a brief statement on its website, NGAUS said Congress authorized the change in the fiscal year 2020 National Defense Authorization Act.

The Defense report attributed the nearly nine-year wait for the option to “significant cost factors” in implementing the coverage.

If every eligible service member enrolls in Tricare, it will cost the government $489 million to implement the new option at 100% participation. But, the report also said that the shift to Tricare would save taxpayer dollars in the long run.

According to the study, the government spent between $1,614 and $8,084 in health care and administrative costs for Tricare Reserve Select enrollees. They spent between $5,211 and $14,208 on FEHBP enrollees in the same year.

“The Department recognizes that the increase in (Defense Health Program) appropriations may be a challenge, however, the decrease in both DOD and federal expenditures due to a shift from higher FEHBP costs to lower (Tricare Reserve Select) costs should outweigh the (Defense Health Program) increase as a benefit not only to the agency and the service member, but also to the taxpayer at large,” DOD wrote in the study.

Military Dental Care

There are three dental care plans available:

• Active-Duty Dental Program
• Tricare Dental Program (for Guard and Reserves members and their families)
• FEDVIP Dental (for retired service members and their families)

Active-Duty Dental Program

The Active-Duty Dental Program covers civilian dental care (as well as dental care at military dental clinics) and is available to the following:

• Active duty service members
• Service members who need line-of-duty care
• Foreign force members stationed in the U/S.
• National Guard and Reserve members who are (1) on active-duty orders, (2) issued delayed-effective-date orders during pre-activation period or (3) covered by the transitional assistance management program

Civilian dental care is covered when you get a referral from your military dental clinic or you live in a remote location where no military dental clinic is located.

There are no out-of-pocket costs for covered dental services.

Tricare Dental Program

The Tricare Dental Program is a voluntary dental plan available to National Guard or Reserve members who aren’t on active duty or covered by the Transitional Assistance Management Program, as well as their family members. It’s also available for family members of active duty service members.

If you are on active duty, you’ll be eligible for active-duty dental benefits.

Covered services include:

• Exams, cleanings, fluorides, sealants and X-rays
• Fillings, including white fillings on back teeth
• Root canals
• Gum surgery
• Oral surgery and tooth extractions
• Crowns and dentures
• Orthodontics and braces
• Additional benefits for enrollees with chronic conditions and special needs
• Additional cleaning for pregnant women

There is no cost sharing for diagnostic and preventative dental treatment. Cost sharing for other procedures ranges between 20% and 50%, depending on the procedure and your pay grade.

You can check the cost-sharing percentages on the Tricare Dental Program cost-sharing page.

There is a maximum benefit of $1,800 per person per contract year, as well as an annual maximum of $1,200 per person for accident care.

There is also a lifetime maximum of $1,750 per person for orthodontic treatment.

FEDVIP Dental

The Federal Employees Dental and Vision Insurance Program, or simply FEDVIP Dental is available for the following:

• Retired service members
• Family members of retired service members
• Retired Guard and Reserve members
• Family members of retired Guard and Reserve members
• Medal of Honor recipients
• Family members of Medal of Honor recipients
• Survivors

FEDVIP Dental is a voluntary program and does involve costs.

The program works with nine different dental insurance carriers, including Aetna Dental, Delta Dental, MetLife, United Concordia Dental and Humana. Premiums, covered services and cost sharing will vary by each provider.

For example, Delta Dental offers two plans that include 100% coverage on cleanings, X-rays and exams from in-network providers.

It also provides additional cleaning for Type I or Type II diabetics. The High Plan has a $30,000 in-network annual maximum and offers adult orthodontic coverage.

Deductibles under the two plans range from $0 to $75, and coinsurance from 0% to 50%.

Monthly premium rates vary by geographic location, so you should investigate all nine plans before deciding which one will work best for you.

Military Health Care for Retirees

Active duty retirees are eligible for Tricare Prime until they reach age 65.

If you’re retired and eligible for Medicare Parts A and B, then you’re eligible for Tricare for Life. It functions as a military equivalent of a Medicare supplement.

There is no annual or monthly enrollment fee for Tricare for Life. You must pay Medicare Part B premiums, then Tricare for Life will pay medical expenses after Medicare. The expenses must be incurred in either the US or US territories.

In overseas areas, Tricare for Life will be the first payer.

You can participate if you are active duty, retired or Guard/Reserve members.

Your family members are also eligible if they are registered in the Defense Enrollment Eligibility Reporting System (DEERS).

Benefits and plans will vary depending on your beneficiary category. This include active-duty service members and families, National Guard or Reserve members and families, retired service members and families or Retired Reserve members and families, among others.

As to benefits, Tricare for Life works closely with Medicare. Essentially, the plan pays for those costs not covered by Medicare.

This leaves the member with no out-of-pocket costs for many common medical expenses, such as hospital stays up to 150 days and skilled nursing facilities, up to 100 days.

However, there are out-of-pocket costs if you’re hospitalized for more than 150 days or in a skilled nursing facility for more than 100 days. In all cases, there is a 20% cost-share for chiropractic services.

There are some charges associated with the program and the Medicare tie-in. For example, there is a deductible of $150 per individual, and $300 per family.

There’s also a catastrophic cap of $1,000. Pharmaceutical co-payments are the same as they are for Tricare Select.

You can view all costs for the program on the Tricare For Life cost page.

Military Health Care for Retired Guard and Reserve Members

 Reserve Component members who retire will be eligible for Tricare Reserve Select Retiree, which has higher premiums. It is essentially the same plan but without subsidies for the premiums.

Here are more health care options for retired members of the Reserve Component.

Reserve Component retirees are eligible for the same military retiree health care as active-duty members when they reach age 60. See the next section for full details.

Other Plans for Military Retirees

Retired service members and their families are also eligible for Tricare Prime, Tricare Select, US Family Health Plan (available in limited areas) and Tricare Select Overseas.

Military Health Care Options After Separating from the Military

The military may provide additional health care options to service members and their families for a limited time after separating from the military.

• Transitional Assistance Management Program (TAMP) – Available to military members and their families when the service member has an unplanned exit from the military (force shaping, medical discharge, etc.)
• Continued Health Care Benefit Program (CHCBP) – Available to all military members and their families when they leave the military; similar to a civilian COBRA program.
• VA Health Care – Provided by the Department of Veterans Affairs to eligible veterans; each situation is unique — veterans should apply directly through the VA
• Tricare Prime – Active-duty retirees and their family members
• Tricare for Life – Military retirees who are eligible for Medicare (age 65 and older)
• Tricare Reserve Select Retiree – Retired members of the Guard and Reserves

Many civilian employers also offer affordable health care coverage. Alternatively, you can shop through a health sharing ministry or through the Affordable Care Act health care exchanges. This article covers your health care options after leaving the military.

Final Thoughts on Military Health Care

As you can see, there are medical and dental programs available for current and former military members at all stages of their careers and their lives.

On balance, the plans are less expensive and more comprehensive than what is available to the general civilian population.

Carefully evaluate any plan you’re considering and get advice from plan administrators. These plans are good, but the terms can be fairly complicated.

Also, be aware that the plan you select now will be subject to change, based on your service level and other factors.

About Post Author