FALLS CHURCH, Va. –
Are you or your sponsor in the
National Guard or Reserve? Your health coverage changes when activating or deactivating. Here’s what you need to know.
“National Guard and Reserve members have different TRICARE coverage options when they transition between active and inactive status,” said Brian Smith, senior health system specialist, TRICARE Health Plan, at the Defense Health Agency. “TRICARE encourages you to review your health coverage options to ensure you maintain continuous health coverage. Do this prior to coming on active duty orders for more than 30 days and deactivating.”
What are my TRICARE options when I activate?
You get the same health care benefits as
active duty service members when you’re activated for more than 30 days on qualifying orders. Your service updates your TRICARE eligibility in the
Defense Enrollment Eligibility Reporting System. Your service does this each time your duty status changes.
Did you receive delayed effective-date, active duty orders for more than 30 days in support of a contingency operation or under 12304b? Then you get early TRICARE eligibility up to 180 days from the date your active duty begins. Do you want more information? Visit TRICARE Pre-Activation Benefits.
Here are things to consider:
- Your TRICARE health plan. You’ll be automatically enrolled in TRICARE Prime as an active duty service member. You’ll have an unassigned primary care manager. This means you can see any TRICARE-authorized provider. You’ll follow your command’s guidance on any additional enrollment requirements when you arrive to your final duty station. The following TRICARE Prime health plans may be an option:
- Your family gets coverage, too. Eligible family members may enroll in a TRICARE health plan. This depends on where they live at the time of your activation. They must act and enroll in one of these health plans within 90 days of your activation.
- Dental coverage changes. Did you have TRICARE Dental Program coverage prior to activation? You’ll be automatically enrolled in the Active Duty Dental Program. This is described in the TRICARE Active Duty Dental Program Brochure. Your enrolled family members keep their TDP coverage with lower premiums. Family members who aren’t enrolled can join anytime.
Are you wondering how to get care while activated for more than 30 days? Do you have TRICARE Prime?
Do your family members have TRICARE Select coverage?
- They can get care from any TRICARE-authorized provider.
- They can get care at a military hospital or clinic if space is available.
- They don’t need referrals in most situations. They may need pre-authorizations for some health care services.
Do you live and work more than 50 miles from a military hospital or clinic? Your family members may enroll in TRICARE Prime Remote. You can check to see if you’re in a remote location—use the TRICARE Plan Finder. Your family members get most of their care from a TRICARE-authorized provider with TRICARE Prime Remote.
What about line of duty care?
Line of duty care is limited to ailments incurred or aggravated during a period of qualified duty 30 days or less. This includes injuries sustained while traveling to and from and staying overnight at a duty station. Your unit is responsible for initiating an LOD determination request.
LOD isn’t a government lifetime health plan. It’s a special eligibility status to treat a specific condition for up to one year. The process for getting LOD care depends on where you’re located. Check out Line of Duty Care for Service Members to learn more.
How about when I deactivate?
Once your active duty period ends, your TRICARE coverage options depend on the type of orders you were under.
Were your active duty orders more than 30 days in support of a contingency operation or under 12304b? If so, you’d be eligible for Transitional Assistance Management Program coverage for 180 days. You and your eligible family members are covered as active duty family members. Your TRICARE health plan options depend on where you live with TAMP coverage. TRICARE Prime Remote isn’t available during TAMP. You must act and submit your new enrollment request within 90 days from your last date on active duty. If you fail to do so, you’ll only be eligible for coverage at a military hospital or clinic.
After TAMP coverage ends, or if you weren’t eligible for TAMP and your active duty period ends, you may have options. You may buy TRICARE Reserve Select coverage if you qualify. Or you may be eligible for Continued Health Care Benefit Program coverage. You may also seek health care insurance through your state’s Health Insurance Marketplace.
You maintain TRICARE pharmacy benefits during TAMP or other TRICARE health plan options.
Is there dental coverage after deactivation?
- Active duty dental benefits continue during TAMP.
- Your TDP coverage and premiums return to regular rates when TAMP or other TRICARE coverage ends.
- Your family members’ TDP coverage continues without interruption.
Do I get retirement coverage?
You may keep TRICARE coverage after retirement. This is if you complete 20 qualifying years of service.
Are you retiring from the National Guard or Reserve? Are you under age 60? You may buy TRICARE Retired Reserve if you qualify. TRICARE Retired Reserve is a premium-based health plan. For more information, visit TRICARE Retired Reserve.
Have you turned age 60 and are drawing retirement pay? You may enroll in TRICARE Prime or TRICARE Select.
Are you under age 60 and drawing retirement pay due to active duty segments? You aren’t eligible to enroll in TRICARE Prime. You may buy or continue coverage under TRICARE Retired Reserve.
Want to make sure your family keeps their health coverage during these transitions? Review all your TRICARE options. You can contact your regional contractor with any questions. You can also visit the TRICARE website to learn more.
Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions to get benefit updates, news, and more.