What is Co-Managed Care for Veterans?

Search Discussions

Start a Discussion

Something on your mind? Get involved and start your own discussion now!

Start a Discussion

TRICARE Reserve Select Basics

With the unemployment rate among reserve component servicemembers skyrocketing, thousands are having trouble finding affordable medical insurance. The need is acute for those with pre-existing conditions of any kind – and especially so if those pre-existing conditions aren’t service related, or it’s a family member who has them.

Fortunately, if you are drilling reservist or Guard member, you can qualify for TRICARE Reserve Select – an affordable and comprehensive major medical plan that compares favorably with most workplace plans in the civilian sector – at about half the cost, except for the very young.

Here are the answers to some frequently asked questions about TRICARE Reserve Select.

Am I eligible?

You are generally eligible if you are a member of the Selected Reserve. This means you belong to a reserve component unit and are on drill status.

Is my family covered?

They are if you want them to be – and if you can pay the monthly TRICARE premiums. You can buy a plan covering just you, or a plan that covers your spouse as well as your dependents.

How Much Does it Cost?

As of mid-2012, TRICARE Reserve Select did have some out-of-pocket-costs including these monthly premiums:

  • Service member only: $54.35
  • Member-and-family: $192.89

This pricing is extremely favorable, when you compare it to typical insurance costs in the private sector. A recent survey found that in 2011, it cost civilian employers nearly $10,000 in medical insurance premiums per employee to provide health coverage for their workers for one year. Even assuming employees are only paying half the premiums in group plans, TRICARE premiums are only a fraction of what many private sector employees pay for their own coverage.

What’s covered?

TRICARE Prime provides substantial financial assistance to help you cover the costs of these important medical conditions.

  • Emergency Care
  • Outpatient Visits
  • Preventive Care (wellness exams, immunizations, etc.)
  • Hospitalization
  • Maternity Care
  • Mental/Behavioral health
  • Prescriptions

What are the deductibles?

The deductible depends on your rank. If you are an E-4 or below, your annual deductible is $50 for individual plans and $100 for family plans. If you are an E-5 or higher, your annual deductible increases to $150 for individuals and $300 for families. Again, these deductibles are lower than comparable plans in the private sector, which generally range from $500 to $5,000 per year for individuals and can run even more for families.

Do I pay anything after I meet my deductible?

Yes. You are generally expected to pay coinsurance, which is a percentage of the medical expenses over and above your deductible. For example, if you have a $100 dollar deductible and 85 percent coinsurance, and you have $1,000 in medical expenses during that year, you would have to pay $100 out of pocket, plus 15 percent of the remaining $900, for a total outlay of $235. This figure disregards any copays for office visits.

Is my coinsurance always 15 percent?

For most types of medical care, your coinsurance is 15 percent if the care provider is within TRICARE’s network of approved providers. If you go outside the network, you can usually expect your coinsurance to be 20 percent. However, your coinsurance for hospice care or home health care is generally zero.

Are newborns covered?

Yes, care for newborn infants is covered. The cost structure is as follows:

  • In-network: The lower of the number of hospital days minus 3 multiplied by $250 or 25% of the negotiated rate for institutional services, plus 20% for separately billed professional charges.
  • Out-of-network: The lower of the number of hospital days minus 3 multiplied by DRG per diem copayment or 25% of billed charges for institutional services, plus 25% for separately billed professional charges.

How about dental care?

Reserve and Guard members are eligible for dental care under the TRICARE Dental Program. There’s a minimum 12-month enrollment period, so you must enroll at least a year before you ETS. Family members are also eligible. If you go on active duty for more than 30 days, your premiums will be suspended, though family member premiums will continue.

The TRICARE Dental Program covers the following services:

  • Diagnostic and preventive services (exams, cleanings, fluorides, sealants, and X-rays)
  • Basic restorative services (fillings, including tooth-colored [white] fillings on back teeth)
  • Endodontics (root canals)
  • Periodontics (gum surgery)
  • Oral surgery (tooth extractions)
  • Prosthodontics (crowns, dentures)
  • Orthodontics (braces) Children are covered up to age 21 or 23 (based on student status, learn more)
  • Spouses are covered up to age 23
  • National Guard/Reserve sponsors are covered up to age 23
  • Scaling and root planing (deep cleaning) for diabetics at no cost

How much does the TRICARE Dental Program for reserve component troops cost?

If you’re drilling – that is, a member of the Selected Reserve, the costs are as follows:

  • Sponsor only: $10.30 per month
  • Single: $25.74 per month
  • Family: $77.22 per month
  • Sponsor and family: $87.52

If you’re in the IRR, you can still qualify, but you’ll pay more:

  • Sponsor only: $25.74 per month
  • Single: $25.74 per month
  • Family: $77.22 per month
  • Sponsor and family: $102.96

The “single” rate and “family” rates listed above do not include the sponsor. For example, these are the rates your spouse or family would pay if you entered active duty, and you were no longer covered under the TRICARE Dental Program.

Coinsurance rates range from zero to 50 percent, and are slightly higher for members above E-5 than for junior enlisted troops.

Share This