TRICARE covers retired reservists

  • Published
  • By Senior Airman Katie Spencer
  • 482nd Fighter Wing Public Affairs
HOMESTEAD AIR RESERVE BASE, Fla. --  Whether the time in service was 20 or 35 years, reservists are entitled to certain medical benefits through TRICARE.

There are a few TRICARE programs Reserve retirees can choose from in order to ensure medical coverage. TRICARE Standard, TRICARE Retired Reserve and TRICARE Prime are three of these programs which offer benefits for retired reservists and their families.

TRICARE Standard: from ages 60-65

TRICARE Standard is a fee-for-service program and is an automatic entitlement for retirees to receive at age 60. There's no enrollment paperwork; however, member information must be current in the Defense Enrollment Eligibility Reporting System. DEERS is a worldwide database of service members and their families who are eligible for military benefits and should be updated if the member gets married, has a baby, adopts etc.

After clarifying eligibility in DEERS, retirees and dependents can receive healthcare with a current ID card. There are two types of providers; network and non-network.

Network providers have a signed agreement with the regional TRICARE office to provide care and are cheaper than non-network providers. Non-network providers are the opposite; they don't have a signed contract and thus care is more expensive when the non-network option is chosen.

TRICARE Standard members who are single have a $150 deductible and pay 20 percent of what the medical appointment costs after the deductable has been met for network providers and pay 25 percent for non-network providers. Retirees with dependents have a $300 deductible (total for all dependents) and also pay the 20 percent cost-share, or cost of the appointment, and pay 25 percent for non-network providers after the deductable has been met.

If for some reason medical care goes over $3,000 in a fiscal year, also known as a catastrophic cap, the member will not have to pay the 20 or 25 percent of the cost-share, and medical care will be fully covered by TRICARE.

TRICARE Retired Reserve: From retirement - age 60

Another program Reserve retirees are eligible for is TRICARE Retired Reserve.

TRR is a health plan which members of the retired Reserve may enroll and purchase. Once purchased, TRR coverage begins in any month of the year. According to the TRICARE Retired Reserve handbook, applications must be postmarked or received no later than the last day of the month before coverage is to begin, and coverage will start on the first day of the first or second month (whichever was selected on the form).

The 2011 monthly premiums for TRR are $408.01 for the member only and $1,020.05 for the member and dependents. The deductibles, percentages of cost-shares and catastrophic cap from TRICARE Standard also apply to TRR.

This option is available until the retiree turns 60, at which point the member and their dependents will be switched from TRR to TRICARE Standard, or the member may opt to enroll in TRICARE Prime.

TRICARE Prime: Ages 60-65

TRICARE Prime is similar to TRR in that the member must enroll and purchase the program. The premium for the member only is $21.66 monthly or $260 annually. For the member and their family, the monthly premium is $43.33 or $520 annually. There's no deductable and no percentage of the cost-share. However, there is a co-payment of $12 per visit to be paid by the beneficiary or family member.

If the member and their family opt to enroll in TRICARE Prime, one thing to consider is the location of where they live.

TRICARE Prime members have the option to choose a Medical Treatment Facility, usually on or near a military installation, as their primary care doctor. This option is available if the member lives within driving distance of an MTF and is on a space available basis. If the member and their family live out of range of an MTF, then a civilian care provider within the network is permitted and will be covered.

This program is available from the time the beneficiary turns 60 to age 65.

Regardless of what TRICARE program the retiree chooses, once the member turns 60 and becomes entitled to medical benefits, they're also entitled to use an MTF for pharmacy, immunizations and optometry needs with no cost to the member or family.

Retired reservists also need to consider coverage under Other Health Insurance. If a member has OHI, meaning insurance through a civilian job or other insurance programs, they must follow the rules of the OHI as TRICARE will always be the second payer in those instances.

TRICARE Standard, TRR and TRICARE Prime are three of the options retired reservists can look into for medical care after their time in service is complete. There are also other TRICARE options available after the member turns 65.

So, after the boots and uniform come off for the last time, rest easy knowing there are several health care programs available for retired reservists.

For more information on enrollment, forms and general questions, please visit www.humana-military.com or call 1-800-444-5445 (Please note this is the TRICARE South Region contact information).