How to choose between TRICARE Reserve Select and civilian health insurance

As a Reserves or National Guard service member, you might have access to three health insurance plans: TRICARE Reserve Select, your employer-provided health insurance and a privately purchased plan.

Deciding which is best for you starts with understanding each option.

Read on for a deep dive into TRICARE Reserve Select, as well as help through the decision-making process that you can apply to the plans available to you.

TRICARE Reserve Select

TRICARE Reserve Select is a health care plan available to eligible members of the Reserves and National Guard and their families. While active-duty members are eligible for TRICARE, members of the Selected Reserve are only eligible for TRICARE Reserve Select if they meet certain qualifications, which are on the TRICARE Reserve Select page Opens in a New Window.‍ ‍ ^{See note 1}

TRICARE Reserve Select covers members of the Reserves and National Guard when they're not activated and thus covered by active-duty TRICARE benefits.

Unlike active-duty TRICARE, TRICARE Reserve Select acts more like a civilian health insurance plan with monthly premiums, deductible, a catastrophic cap and copays. You can see these numbers on the TRICARE Costs Compare page Opens in a New Window.‍ ‍ ^{See note 1}

It’s important to consider what you need from your plan, how it fits in your budget and what benefits you can expect to receive as you shop for health insurance. Also, consider where you want to receive care when you need it and what you can afford when it comes to deductibles and other cost-sharing factors.

Insurance based on your needs

You know your medical needs and preferences better than anyone. Consider how you like to receive care. Do you prefer to have a primary care doctor who will refer you to a specialist as needed, or do you prefer to see a medical provider of your choice? The plan type you choose may provide for either option, but plan types will vary and so will premium costs.

TRICARE Reserve Select, like many private insurer plans, uses a network of providers to reduce expenses. If you visit an out-of-network provider, you'll likely pay higher costs.

Private insurers offer a similar structure called a health maintenance organization (HMO). Within an HMO, the primary care provider serves as the "quarterback" for your medical service needs. TRICARE doesn’t require referrals for any type of care, but you may need preauthorization for some services to be covered. With TRICARE Reserve Select, you also have access to military hospitals or clinics on a space-available basis.

With TRICARE Reserve Select, when you see an in-network provider, your claim will be automatically filed for you. But you're responsible for filing your claim if you see an out-of-network provider.

If you're already seeing a provider, you can still go to them for your medical needs, but you should first confirm that they accept TRICARE and determine whether they're within the TRICARE network of providers.

TRICARE Reserve Select costs

Compared to a private insurer plan, TRICARE Reserve Select may be more affordable, especially when you consider the low deductibles and catastrophic cap of the plan. For example, the average family deductible for employer-based health insurance plans in 2022 was $3,811, according to Kaiser Family Foundation research Opens in a New Window.‍ ‍ ^{See note 1}

The catastrophic cap or maximum out-of-pocket limit for these plans may be much higher Opens in a New Window.‍ ‍ ^{See note 1} Plans offered for the 2024 plan year through the federal health care exchange can’t have limits over $9,450 for individuals and $18,900 for family plans.

Most costs are for calendar year 2024. For more information and additional details about expenses you can expect on the plan, visit tricare.mil Opens in a New Window.‍ ‍ ^{See note 1}

Private insurer plans versus TRICARE Reserve Select

Most Americans receive their insurance coverage through an employer-provided plan. This arrangement splits the costs between the employer and the employee. There often are many plans to choose from with different costs and provider choice options.

If you have coverage available to you through your civilian employer, it makes sense to compare the plan benefits and projected costs to TRICARE Reserve Select, as long as you maintain eligibility for the latter.

If your civilian employer doesn't offer health insurance or if you're self-employed, plans are available through private insurance companies and the federal health care exchange. Depending on your estimated household income, you may qualify for a premium tax credit, which can reduce your monthly premiums on health insurance plans acquired through the exchange.

It's important to consider your options in relation to your medical needs. You may be able to find a fully subsidized health insurance plan through the federal exchange and pay nothing per month, but you may be on the hook for a substantial deductible.

TRICARE Reserve Select may be the lowest-cost comprehensive health insurance plan when compared with civilian plan types, but it hinges on your eligibility for the program.

If your reserve status changes and your eligibility is impacted, you may have transitional programs available to help as you switch from the TRICARE system to civilian health insurance.

Compared with the price of a TRICARE plan, the high cost of civilian health care expenses can come as a shock for transitioning service members. Take advantage of TRICARE's lower costs while you can and use that time as an opportunity to improve your financial position for the future.

It's important to make this analysis each time you change civilian jobs because each employer-provided health insurance plan will likely be different than the one before.

Take your time as you make this decision. Doing some research and analyzing how each health insurance plan fits you and your family can save you money in the long run.