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TRICARE Retired Reserve Coverage

Retired 1st Lt. Phillip B. Fikes

The TRICARE Retired Reserve program offers quality health insurance to retired reservists, guard members, and their families. TRICARE Retired Reserve is a premium-based insurance which offers discounted and free medical care, however there are some limitations and deductibles. 

TRICARE Retired Reserve is minimum essential coverage under the Affordable Care Act

Premiums

By law there is no government subsidy so you must pay the full premium for this plan, the current monthly premiums are:

  • Member Only: $388.79 (changing to $402.81 January 1, 2017)
  • Member Plus Family: $957.44 ( changing to $1,013.36 January 1, 2017)

When you enroll you have to pay the first 2 months premiums up front.  You can pay with check, money order, or debit/credit card. From then on out all payments must be made by bank transfer (EFT), or recurring payment from a debit/credit card. All payments are made directly to the regional contractor. 

Cost Share and Co-pay 

Under the TRICARE Retired Reserve program you will have cost share (co-pay) for certain procedures, this means that you will have to pay for a portion of the treatment out-of-pocket. This table shows some of the cost share percentages:

TRICARE Retired Reserve Cost-Shares
Type of Care Network Non-Network
Ambulatory Care (Same Day Surgery) 20% of the negotiated rate 25% of the allowable charge
Mental Health Inpatient: 20% of the total charge, plus 20% for separately billed services Outpatient: 20% of the negotiated rate Inpatient:
  • High Volume Hospital-25% of the hospital-specific per diem
  • Low Volume Hospital-$224 per day or 25% of the billed charges, whichever is less
Outpatient: 25% of the allowable charge
Home Health Care     $0 $0
Hospice Care $0 $0
Hospitalization   $250 per day or 25% of billed charges, whichever is less, plus 20% for separately billed services. $848 per day or 25% of billed charges, whichever is less, plus 25% for separately billed services.
Maternity Care Global fee for office visits hospitalization for delivery planned in a hospital: $250 per day or 25% of billed charges, whichever is less, plus 20% for separately billed services Office visits for delivery planned in a birthing center, home or other setting: 20% of the negotiated rate Global fee for office visits hospitalization for delivery planned in a hospital: $848 per day or 25% of billed charges, whichever is less, plus 25% for separately billed services. Office visits for delivery planned in a birthing center, home or other setting: 25% of the allowable charge
Newborn Care The lower of the number of hospital days minus 3 multiplied by $250 or 25% of the negotiated rate, plus 20% for separately billed professional charges. The lower of the number of hospital days minus 3 multiplied by $848 or 25% of billed charges, plus 25% for separately billed professional charges.
Outpatient Services (which include):
  • Ambulance Services
  • Durable Medical Equipment
  • Emergency Room Visits
  • Laboratory Services
  • Preventive Services*
  • X-Rays
20% of the negotiated rate 25% of the allowable charge
Skilled Nursing Care (Inpatient)** $250 per day or 25% of billed charges, whichever is less, plus 20% for separately billed services. 25% of billed charges, whichever is less, plus 25% for separately billed services.

*The following Preventive Services are available free of charge: colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6.
**Skilled Nursing is only available in the U.S. and U.S. Territories.

There is also a deductible amount for this program. The deductible is what you must pay out-of-pocket before the insurance begins paying anything. The current annual deductible is $150 per individual or $300 per family.

Related Topics

TRICARE Retired from Military Military Reserves

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