Healthcare When Going from Active Duty to National Guard
There will be quite a few changes for those that make the decision to transition from active duty to National Guard. One of the biggest changes will be with healthcare when going from active duty to the National Guard or Reserves.
Healthcare From Active Duty to National Guard
As an active duty service member, you probably have one of the following:
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Prime Overseas
- TRICARE Prime Remote Overseas
- TRICARE Select
- TRICARE Select Overseas
You are probably not used to paying a monthly fee for your health insurance, and your out of pocket costs are most likely quite low.
It is important to keep in mind that this has been a big benefit as serving as active duty, and with your change in service, you will no long be eligible for what you had before. However, that does not mean you will be stuck with unaffordable health insurance. If you are making this transition, it is important to know what your options are.
In a lot of cases, those who make the transition to national guard from active duty can qualify for TAMP or the Transitional Assistance Management Program. This program provides 180 days of premium-free transitional health care benefits after your regular TRICARE benefits end.
For you and your family members to be eligible for TAMP, you, as the sponsor, would need to be:
- Involuntarily separating from active duty under honorable conditions which include members who receive a voluntary separation incentive (VSI,) or members who receive voluntary separation pay (VSP) and aren’t entitled to retired or retainer pay upon separation, or
- National Guard or Reserve member who is seperating from a period of more than 30 consecutive days of active duty served for a preplanned mission or in support of a contingency operation, or
- Separating from active duty following involuntary retention (stop-loss) in support of a contingency operation, or
- Separating from active duty following a voluntary agreement to stay on active duty for less than one year in support of a contingency operation, or
- Receiving a sole survivorship discharge, or
- Separating from regular active duty service and have agreed to become a member of the selected reserve of a reserve component. You must become a selected reservist the day immediately following your release from regular active duty service.
TAMP eligibility can be viewed by going to MilConnect. You should also check with your service personnel department for information or assistance with TAMP eligibility.
The 180-day TAMP period begins when you seperate. During the TAMP period, sponsors and family members are eligible to use one of the following health plan options in addition to going to military hospitals and clinics:
- TRICARE Prime
- TRICARE Select
- US Family Health Plan (enrollment required and must live in a designated location.)
- TRICARE Prime Overseas (enrollment required)
- TRICARE Select Overseas
- Extended Health Care Option
What About During Terminal Leave?
During terminal leave, you will still receive active duty benefits and will be covered under TRICARE Prime, TRICARE Prime Remote, or TRICARE Select. In some cases you might be able to receive Line of Duty Care, and will need to contact your unit or service branch for more information or assistance.
If you want to keep your TRICARE benefits once you have moved to the national guard, and after TAMP expires if you qualify, you can do so with TRICARE Reserve Select. While you are serving in the national guard, your status will change during the time you are serving. This is important as it also changes the status of your TRICARE benefit.
You are considered inactive when you are on military duty for 30 days or less. This includes when you go to your inactive duty for training, which is your weekend drills, during your annual training, and any other active service that is less than 30 days.
Members of the selected reserve as well as their families can qualify as long as they are not on active duty orders, not covered under TAMP, and not eligible for or enrolled in the Federal Employees Health Benefits Program (FEHB.)
TRICARE Reserve Select is a premium-based plan which means you will have to pay a monthly fee to have it. For a family, that cost would be $218.01 a month, for an individual the cost would be $42.83 a month.
When you have TRICARE Reserve Select you would schedule your appointments with any TRICARE-authorized provider. There are non-network providers, where you would pay higher cost shares and may have to file your own health care claims, and network providers, where you would pay lower cost shares and the provider will file the claims for you.
You can also request an appointment at a military hospital or clinic on a space available basis and you do not need referrals for any type of care, but you might need to get prior authorization from your regional contractor for some types of services.
In addition to paying for your monthly premiums, you will also have an annual deductible, and a cost share. You can read more about these costs here.
Your prescriptions would be filled through the TRICARE Pharmacy Program. You and your family will also be able to enroll in the TRICARE Dental Program. Though, you will enroll separately from your family and pay separate monthly premiums.
You can enroll for TRICARE Reserve Select either online or by phone.
Some will be able to qualify for Line of Duty Care. You may qualify if you incur or aggravate an injury, illness, or disease while in the line of duty. This also includes with you are traveling to and from your place of duty. Your unit will need to issue a Line of Duty (LOD) determination or a NOE if you are in the Coast Guard. In order to verify your eligibility contact your unit administrator or medical representative.
It is important to keep in mind that Line of Duty Care is separate from any other TRICARE coverage including TAMP, TRICARE Reserve Select, and pre-activation benefits when you qualify for them upon federal activation. Line of Duty Care is also not considered minimum essential coverage under the Affordable Care Act. Line of Duty dental care is provided through the Active Duty Dental Program.
Your Employer’s Insurance
Going with your new employer’s insurance is always an option too. You don’t have to go with TRICARE Reserve Select. However, in a lot of cases, doing so will be more affordable for you and your family. Trying to decide what to do? Take a look at your options and go with the plan that works best for you and your family’s needs.
If You Become Activated
If you become activated as a someone in the national guard, you would then become eligible for the same health and dental benefits as active duty service members. Unless you qualify for early pre-activation benefits, you will start these new benefits on the first day of your orders. As far as the Dental program goes, you would be automatically disenrolled from the TRICARE Dental Program and will begin using active duty dental benefits. Your family will stay enrolled but have reduced premiums.