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TRICARE for National Guard and Reserve Members

Joe Wallace

TRICARE Benefits for Reserve and National Guard Members

Members of the National Guard, Reservists, and their families may be eligible for coverage under TRICARE. Eligibility depends on the service member’s military status, which may change many times over a career in the Guard or Reserve. Your care options may vary depending on whether your current status is:

• Inactive
• Activated
• Deactivated
• Retired

You and your family can verify basic eligibility for TRICARE via the Defense Manpower Data Center or by logging into Beneficiary Web Enrollment (BWE) on the MilConnect official site. Family members are eligible if they are listed in DEERS and the service member qualifies for TRICARE.

To log in to these portals to check TRICARE eligibility, you need one of the following:

• Common Access Card (CAC),
• DFAS (MyPay) Account, or
• DoD Self-Service Logon (DS Logon) Premium (Level 2) account

What TRICARE Benefits Are Provided for Reserve and National Guard Members?

The TRICARE benefits and health plan options below depending on the service member’s status.

• Line of Duty Care
• TRICARE for Inactive Guard/Reserve (on duty 30 days or less)
• TRICARE When Activated (on duty for more than 30 days)
• TRICARE When Deactivated
• TRICARE When Retired

TRICARE Line Of Duty Care

Line Of Duty care applies to members of the Guard and Reserve who, “…incur or aggravate an injury, illness, or disease while in the line of duty” which can include drill weekend, ADT, IDT, or other training as specified on orders. Coverage is provided for travel to and from official duty as well.

You will not show up in DEERS as being eligible for TRICARE under these circumstances, However, Line Of Duty coverage is meant to anticipate circumstances that may result in an emergency room visit during military training in a Guard/Reserve capacity. Line Of Duty care is completely separate from other TRICARE coverage such as TRICARE Reserve Select, pre-activation benefits you may be entitled to when called to federal service, and benefits provided under military transition assistance programs.

Due to the nature of this coverage, TRICARE Line of Duty coverage is NOT considered minimum essential coverage for the purposes of meeting the requirements of laws like the Affordable Care Act.

TRICARE for Inactive Guard/Reserve on Duty for 30 Days or Less

TRICARE Reserve Select is offered to those who are not on active duty orders, not covered under other Transition Assistance programs such as TAMP, and to those who are not eligible for the Federal Employee Health Benefits program. TRICARE Reserve Select is a premium-based health insurance plan offered to qualifying members of the Guard/Reserve and their families worldwide.

The TRICARE official site notes that those in the Individual Ready Reserve do not qualify for this healthcare option.

If you have TRICARE Reserve Select, you may get care from an authorized provider in your network or out-of-network.

TRICARE for Activated Guard and Reserve Members

Those who are activated and placed on active duty status are enrolled in one of the following plans depending on the location of duty; stateside, overseas, stateside remote duty, or overseas remote duty. Plans include:

• TRICARE Prime
• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas

You will be covered by one of these plans as applicable but you are required to formally enroll, typically when you arrive at the duty station. Family members may be added to your plan at enrollment time. TRICARE is the only health benefit option you have when activated for federal active duty service. TRICARE coverage allows you to claim zero out-of-pocket expenses when claiming “covered services” and when you do have to pay, TRICARE reimburses you 100%.

TRICARE Coverage When You Are Deactivated

There are two options for coverage when you are deactivated. One is TRICARE Reserve Select (see above) which is offered first. This is for those who are not on active duty orders, not covered under other options such as TAMP, and to those who are not eligible for the Federal Employee Health Benefits program.

When you are deactivated, you have another option to claim benefits under a program called  TAMP; the Transitional Assistance Management Program. This adds 180 days of health care benefits which begin after regular TRICARE benefits end. There are no premiums to be paid for under TAMP.

Who is eligible for TAMP?

Sponsors and eligible family members who meet one of the following conditions:

• • You are involuntarily separating from active duty under honorable conditions
  • You received a voluntary separation incentive (VSI)
  • You received voluntary separation pay (VSP) and can’t receive retired or retainer pay upon separation.
  • You are a Guard or Reserve member separating from a period of more than 30 consecutive days of active duty for a pre planned mission, or working to support a contingency mission or COVID-19 response
  • Separating following involuntary retention (AKA “stop loss”) in support of a contingency operation
  • Separating after agreeing to remain on active duty for less than one year in support of a contingency operation
  • Receiving a sole survivorship discharge
  • Separating from regular active duty service and agreeing to become a member of the Selected Reserve of a Reserve Component.

You can view your eligibility for TAMP in DEERS or via MilConnect.

TAMP Coverage Periods

During TAMP coverage periods, you and your family members may qualify to enroll for or use one of the following:

• • Military care facilities
  • TRICARE Prime
  • TRICARE Select
  • US Family Health Plan
  • TRICARE Prime Overseas
  • TRICARE Select Overseas

As mentioned earlier in this article, TRICARE coverage options like Prime and Select are based on duty location.

TRICARE When Retired

If you retire from military service, having served the full duration of a military career 20 creditable years or more in the Guard or Reserve, you may qualify for TRICARE benefits as a military retiree. It’s important to note that you must draw a military pension or be eligible to draw one to qualify. Being retired in a non-military sense has no bearing on this coverage or its availability.

Retired Reserve members and their families have TRICARE options which are based on the age of the military member. For those under 60 years old, you may qualify to buy into TRICARE Retired Reserve; turning down this option means you will not qualify for other TRICARE retiree coverage until you turn 60.

For those who opt-in to TRICARE Retired Reserve who have children who are about to age out of TRICARE, an option called TRICARE Young Adult may help.

For those ages 60 or older,  the TRICARE official site says, “you and your family become eligible for the same TRICARE health benefits as all other retired service members” and such options depend on where you live. Stateside the following options apply:

• TRICARE Prime
• TRICARE Select
• TRICARE For Life (with Medicare Part A & Part B)
• US Family Health Plan

Outside the United States, the following options may be offered to you:

• TRICARE Select Overseas
• TRICARE For Life (with Medicare Part A & Part B)

Things to Know About TRICARE Options for Family Members of National Guard or Reserve Members

Your TRICARE coverage is provided when the service member is eligible for the coverage. These scenarios can include circumstances where one of the following applies:

• On military duty for less than 30 days
• Activated

• Called to active duty service for more than 30 consecutive days
• Deactivated-after leaving active duty for more than 30 consecutive days

Did you know you can purchase TRICARE Dental Program coverage? This is an option completely separate from the other TRICARE coverages, and you must enroll for dental coverage. As mentioned above, all dependents to be covered under TRICARE must be registered in DEERS.

Those who are eligible for TRICARE and Medicare Part A should know that you are typically required to carry Medicare Part B in order to continue using TRICARE.