If you’re a reservist or guardsman in search of an affordable and comprehensive health care offering, then Tricare Reserve Select may be the best plan for you and your family. Established by the 2005 National Defense Authorization Act, Tricare Reserve Select aims to offer a military-sponsored health insurance option to members of the Selected Reserve and their families.
Table of Contents
What is Tricare Reserve Select?
Tricare Reserve Select is a premium-based insurance plan, which means that individuals or families must pay an up-front cost (a premium) in order to keep their health insurance policy active. For inactive reservists or guardsmen, the plan is an alternative to procuring health insurance on the open market, where costs are typically higher. Additionally, servicemembers and their families with Tricare Reserve Select can switch their coverage to other Tricare plans, such as Tricare Prime or Tricare Select, if and when the servicemember is activated.
Tricare Select Top Five Facts You Need to Know
- Affordable, Comprehensive Health Care: Compared to other comprehensive health plans in the open marketplace, this is a low-cost option for members of the Selected Reserve with global coverage.
- Must Be Purchased: Unlike other Tricare plans for active duty personnel, this plan must be purchased like other premium-based health insurance plans. Enrollees pay a monthly premium as well as an annual deductible and co-payments.
- Freedom of Choice Among Providers: Beneficiaries are free to choose among any Tricare-authorized providers; however, choosing in-network providers will reduce out-of-pocket costs.
- Only for Inactive Reservists and Guardsmen: Only available to inactive members of the Selected Reserve who are ineligible for the Transitional Assistance Management Program or the Federal Employees Health Benefits Program. Once activated, servicemembers and their families will be eligible for premium-free Tricare health care.
- Possibility for Gaps in Coverage: Transitioning back and forth between active and inactive status, and therefore between Tricare Reserve Select and a premium-free Tricare plan, can result in gaps in coverage. It is, therefore, the responsibility of the servicemember to take a more active role in managing their health care coverage and communicating with Tricare to anticipate and prevent potential gaps in coverage.
Eligibility & Costs
Am I Eligible?
If you or a family member are part of the Selected Reserve (which includes active Air Force, Army Reserve, National Guard, Navy Full-Time Support personnel, and Marine Corps Active reservists) and are not on active duty orders, you are likely eligible.
Groups that are not eligible for Tricare Select Reserve are those covered under the Transitional Assistance Management Program (e.g. servicemembers separating from the service), those enrolled in the Federal Employees Health Benefits program (e.g. civilian federal employees), and members of the Individual Ready Reserve.
The ineligibility of reservists or guardsmen who are concurrently federal employees enrolled in the Federal Employee Health Benefits program is a recurring pain point that initiated a legislative response in 2019. The Tricare Reserve Improvement Act was introduced to Congress and at the time of publication, sits in committee.
Retired members of the Reserve Component are no longer eligible for Tricare Reserve Select, but may transition into Tricare Reserve Select Retired, which is the same insurance coverage without any cost subsidies for the monthly premiums. In other words, it costs a lot more each month. Here are health care options for retired Reservists.
Once retired Reservists and Guard members reach age 65, they will become eligible for Tricare for Life.
Costs
As a premium-based health plan, the main costs of Tricare Reserve Select are monthly premiums, an annual deductible, and cost shares for Tricare-covered services. Currently, 2020 monthly premium rates are $44.17 for an individual or $228.27 for the servicemember plus family.
Cost shares, or co-payments, range from $15-$25 for covered in-network services (e.g. primary care or specialist visits, urgent care) and are traditionally 20% of the cost of the service if the provider is out-of-network.
Finally, the annual deductible — or the maximum amount that beneficiaries will pay out-of-pocket before Tricare begins paying — is $1,000 for Tricare Reserve Select. Keep in mind that monthly premium payments are not applied toward the annual catastrophic cap.
Enrollment Basics
First Time Enrollment
If you are eligible to purchase Tricare Reserve Select coverage, enrollment can be conducted over the phone or online at any time during the year. Keep in mind that enrolling yourself or family members in any Tricare plan first requires an updated DEERS profile. Eligible servicemembers will have to complete a Reserve Component Health Coverage Request Form along with payment to the specified regional contractor (see Important Tricare Reserve Select Resources below).
Re-enrollment Following Activation
When reservists or guardsmen are activated, they and their families become eligible for Tricare plans designed for active duty personnel without paying premiums. In this case, a servicemember’s Tricare Reserve Select coverage would end and transition over to Tricare Prime or Select. Later, when the servicemember deactivates and loses eligibility for premium-free Tricare, they can re-enroll in Tricare Reserve Select so as to ensure no gaps in coverage. This requires the same enrollment steps as above.
Important Tricare Reserve Select Resources
The regional contractors for Tricare Reserve Select are:
- Tricare East (Humana Military): 1-800-444-5445
- Tricare West (HealthNet): 1-844-866-9378
- Overseas (International SOS): See website for regional phone directory
Advantages & Disadvantages
While there are clear advantages to Tricare Reserve Select — namely its low cost and worldwide accessibility — there are a few disadvantages that beneficiaries should be aware of prior to enrollment.
Tricare Reserve Select: Advantages
- Global Coverage: This plan is available to eligible beneficiaries worldwide. Additionally, beneficiaries can seek health care at military treatment facilities on a space available basis.
- Freedom of Choice: Beneficiaries can choose from any Tricare-authorized provider for health care. Selecting in-network providers will lower out-of-pocket costs.
- Referrals Not Required: While some health care services may require pre-authorizations, referrals are not mandated under this plan, thereby reducing the paperwork burden for beneficiaries.
- Affordable Comprehensive Health Care: This plan is more affordable than many comparable health care offerings in the civilian marketplace and is, therefore, a good option for eligible reservists or guardsmen and their families.
Tricare Reserve Select: Disadvantages
- Imperfect Transitions During and After Activation: Although on paper the transition from Tricare Reserve Select to premium-free Tricare and back again in the event of activation should be seamless, in reality, this is rarely the case. Reservists and Guardsmen are often levied with the personal responsibility of maintaining detailed records about their activation and (especially) deactivation dates and communicating with Tricare in order to ensure no gap in coverage. For reservists or guardsmen who are frequently activated, this can pose a recurring issue and require servicemembers to closely monitor their coverage and anticipate any gaps.
- Ineligibility for Reservist or Guardsmen Federal Employees: As the legislation currently stands, members of the Selected Reserve who are concurrently federal employees, and therefore eligible for the Federal Employee Health Benefits Program, are ineligible for Tricare Reserve Select. This essentially forces some 110,000 Reservists and Guardsmen who would otherwise be eligible to avail of the less-expensive Tricare Reserve Select to pay more for their health insurance. While this issue has been introduced in Congress, it currently sits in the House Subcommittee on Military Personnel and Senate Armed Services Committee.
Editor’s Note: This is Ryan Guina, the founder of The Military Wallet chiming in. As a member of the Air National Guard, I can attest to the imperfect transitions between Tricare Reserve Select and Tricare Prime. I have been activated for over 30 days on three separate occasions since joining the Guard over 5 years ago. The transition from Tricare Reserve Select to Prime and back usually goes smoothly, but not always. In one instance, I had an almost two-month break in coverage due to a problem with my orders. Thankfully, the Tricare customer service representative I spoke with was understanding and they backdated one of my claims that occurred during this transition period. But it could have turned out differently. If you experience this situation, make sure you open a case with Tricare, keep good notes, and speak with your supervision at your unit. This is just one of many opportunities for improving Tricare.
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