Military Healthcare For Active, Guard & Reserves, and Retirees

Military healthcare is among the best health coverage available anywhere. It’s as close to no-cost health insurance as you’ll find, and it covers virtually everything. Perhaps the biggest problem with military healthcare is that, like most military insurance plans, it can be difficult to understand. In this article, we’ll provide the basic information, and give…
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Military healthcare is among the best health coverage available anywhere. It’s as close to no-cost health insurance as you’ll find, and it covers virtually everything.

Perhaps the biggest problem with military healthcare is that, like most military insurance plans, it can be difficult to understand.

In this article, we’ll provide the basic information, and give you at least a general understanding of how it works. At least to the degree that anyone anywhere can ever understand any healthcare plan!

Military Healthcare for Active Duty Personnel

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

The plan has two different programs:

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, members who died while on active duty or during retirement, and individuals who were voluntarily or involuntary separated from a service member, such as by divorce.

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

Let’s break down the two plans.

Tricare Prime

As stated above, Tricare Prime is for active duty service members and their families. In fact, if you’re on active duty, you must enroll in Tricare Prime.

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, and accept your co-payments and files 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 using 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 deductible and cost-shares are as follows:

tricare deductible and cost-share chart
Source: https://tricare.mil/Costs/POS

Once again, point-of-service – and the above fees that apply – occurs when 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 are enrolled after January 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. It begins the day the application is received.

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/Reserve members.
  • Non-activated Guard/Reserve members and their families who qualify under the Transitional Assistance Management Program (provides 180 days of premium-free transitional healthcare benefits after regular Tricare benefits end).
  • Retired Guard/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 per individual and $100 per family; E5 and higher, $150 per individual and $300 per family
  • Catastrophic cap, $1,000
  • Outpatient visit, $22 for primary, $33 for specialty; non-network, 20%
  • Urgent care, in-network $22, non-network 20%
  • Emergency services, in-network $89, non-network, 20%
  • Laboratory and X-Ray, in-network, $0, non-network, 20%
  • Ambulance service, in-network, $68, inpatient/non-network, 20%
  • Mental health, in-network, $22-33, non-network, 20%
  • Hospitalization and maternity, in-network & non-network, $19.55 per day
  • Immunizations, $0
  • Pharmacy, generic, military pharmacy $0, home delivery $10, generic retail, $13 (in-network)

Once again, that’s just a summary. They tend to offer other one-off things on occasion, too, like flu shots.

You should also 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 Healthcare 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 than it will be with 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 copayments and cost-shares listed on the Tricare Reserve Select cost page, but here’s a summary of the more significant ones:

  • Enrollment fees, $44.17 per month for the member only, $228.27 for the member and family
  • Deductible, E1 – E4 $52 per individual and $104 per family; E5 and higher, $156 per individual and $313 per family
  • Catastrophic cap, $1,044
  • Outpatient visit, $15 for primary, $26 for specialty; non-network, 20%
  • Urgent care, in-network $20, non-network 20%
  • Emergency services, in-network $41, non-network, 20%
  • Laboratory and X-Ray, in-network, $0, non-network, 20%
  • Ambulance service, in-network, $15, non-network, 20%
  • Mental health, in-network, $15-26, non-network 20%
  • Hospitalization and maternity, in-network, $62, non-network, 20%
  • Hospice and home healthcare, $0
  • Immunizations, $0
  • Pharmacy, generic, $0, (home delivery, $10), generic retail, $13 (in-network)

Tricare Reserve Select is only available to members who are actively serving in the regular Reserves.

Retired Guard and Reserve members. Reserve Component members who retiree 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 healthcare 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.

Military Healthcare 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 you’re eligible for Tricare For Life. It functions as a military equivalent of a Medicare supplement.

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

However, 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. Such can 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. And 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.

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 Healthcare Options After Separating from the Military

The military may provide additional healthcare options to servicemembers 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 servicemember 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. This is similar to a civilian COBRA program.
  • VA Health Care – Provided by the Department of Veterans Affairs to eligible veterans. Each situation is unique and 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 healthcare coverage. Alternatively, you can shop through a health sharing ministry, or through the Affordable Care Act healthcare exchanges. This article covers your healthcare options after leaving the military.

Military Dental Care

There are three dental care plans available:

  • Active Duty Dental Program
  • Tricare Dental Program (for Guard / 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 members:

  • Active duty service members.
  • Service members who need line of duty care.
  • Foreign force members stationed in the US.
  • 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
  • Filings, 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

Monthly premiums are as follows:

Tricare Dental Plan Premiums
Source: https://www.tricare.mil/Costs/DentalCosts/TDP/Premiums

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 also 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.

Final Thoughts on Military Healthcare

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

But on balance, the plans are less expensive and more comprehensive than what are 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.

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About Ryan Guina

Ryan Guina is The Military Wallet's founder. He is a writer, small business owner, and entrepreneur. He served over six years on active duty in the USAF and is a current member of the Illinois Air National Guard.

Ryan started The Military Wallet in 2007 after separating from active duty military service and has been writing about financial, small business, and military benefits topics since then. He also writes about personal finance and investing at Cash Money Life.

Ryan uses Personal Capital to track and manage his finances. Personal Capital is a free software program that allows him to track his net worth, balance his investment portfolio, track his income and expenses, and much more. You can open a free Personal Capital account here.

Featured In: Ryan's writing has been featured in the following publications: Forbes, Military.com, US News & World Report, Yahoo Finance, Reserve & National Guard Magazine (print and online editions), Military Influencer Magazine, Cash Money Life, The Military Guide, USAA, Go Banking Rates, and many other publications.

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  1. Tony says

    Ryan,

    Does the same rule apply to retired active duty at age 65 if they are on Tricare Select? Do we have to switch to medicare part a and b like Tricare Prime participants?

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