United States Government Accountability Office

GAO Report to Congressional Committees

MILITARY HEALTH

Increased TRICARE 

Eligibility for 

Reservists Presents 

Educational 

Challenges 

February 2007 

 

GAO-07-195 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

February 2007

MILITARY HEALTH

Increased TRICARE Eligibility for 

Reservists Presents Educational 

Challenges 

Highlights of GAO-07-195, a report to 

congressional committees 

Since 2001, the number of

reservists mobilized for active duty 

has increased dramatically. 

Congress has expanded reservists’ 

and their dependents’ eligibility for 

TRICARE, the Department of 

Defense’s (DOD) health insurance 

program. The National Defense 

Authorization Act (NDAA) for 

Fiscal Year 2004 directed GAO to 

examine the health insurance 

coverage of reservists and their 

dependents. This report 

(1) identifies the extent to which

reservists have civilian health 

insurance, (2) examines DOD’s 

efforts to educate reservists and 

their dependents about TRICARE, 

and (3) describes reservists’ level 

of satisfaction with TRICARE and

the types of problems reservists 

and their dependents experienced 

when using it. To do this, GAO 

relied on interviews with DOD and 

DOD’s survey data. GAO also 

administered a survey of TRICARE 

benefit assistance coordinators. 

What GAO Recommends

GAO recommends that DOD 

provide additional TRICARE 

briefings to reservists and their 

dependents during regular training

or when they are first notified of

mobilization. DOD partially 

concurred, agreeing that briefings 

should occur when members are 

first informed of mobilization, but 

disagreeing that briefings are 

needed during other periods. GAO

continues to believe that such

briefings would be effective. 

Eighty percent of mobilized reservists have civilian health insurance—a rate 

similar to that of the U.S. population between 18 and 64 years old. The 

number of reservists with civilian health insurance varies among reservists, 

with older reservists and reservists of higher rank having a greater rate of 

insurance than younger reservists and reservists of more junior rank, and 

reservists with dependents being more likely to have insurance than

reservists without dependents. Reservists and their dependents obtained 

coverage through a variety of sources and over half of all reservists kept 

their civilian health insurance during mobilizations, even though they were 

eligible to enroll in TRICARE. Many reservists reported that they maintained 

their civilian coverage to avoid disruptions associated with a change to 

TRICARE and to ensure that their dependents could continue seeing their 

current providers who might not accept TRICARE.

Increased mobilizations of reservists and successive legislative changes that

have increased reservists’ and their dependents’ eligibility for TRICARE have

complicated DOD’s efforts to educate reservists about TRICARE. DOD’s 

primary educational tools are the TRICARE briefings provided at

mobilization sites and demobilization sites. According to DOD officials, 

these days of training are often so full of critical information that it is 

difficult for reservists to absorb all of the details of TRICARE. These 

briefings also occur at a time when a reservist may have already been 

eligible for TRICARE for up to 90 days without realizing it. These briefings 

are supplemented by family support programs, Web sites, toll-free customer 

assistance numbers, and print materials. DOD officials recognize the need to 

improve TRICARE education, but do not plan to provide additional 

TRICARE briefings for reservists and their dependents. 

When reservists used TRICARE, most reported that they were satisfied with 

TRICARE, although some reported experiencing difficulties. Over 60 percent

of reservists who used TRICARE reported being satisfied. In addition, 

70 percent of reservists thought TRICARE was either equal to or better than 

their civilian health insurance. However, according to DOD’s and GAO’s 

surveys, when reservists and their dependents did experience problems with 

TRICARE, a few of the most frequently reported problems include 

difficulties understanding TRICARE, establishing TRICARE eligibility, 

obtaining TRICARE assistance, and finding a health care provider that 

accepts TRICARE. 

www.gao.gov/cgi-bin/getrpt?GAO-07-195.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Marcia Crosse 

at (202) 512-7119 or crossem@gao.gov. 
Contents 

Letter 1

Results in Brief 3

Background 5

Most Reservists Have Civilian Health Insurance, and Many 

Reservists Choose to Maintain Their Civilian Insurance When 

Mobilized 12

DOD Is Challenged by the Task of Educating Reservists and Their 

Dependents about TRICARE 16 

Most Reservists Are Satisfied with Their TRICARE Benefits, but 

Some Reservists Experience Difficulties Using TRICARE 22 

Conclusions 26

Recommendation 26

Agency Comments and Our Evaluation 26 

Appendix I Objectives, Scope, and Methodology 28 

Appendix II Selected Legislation Pertaining to TRICARE 

Eligibility for Reservists 30 

Appendix III Comments from the Department of Defense 31 

Appendix IV GAO Contact and Staff Acknowledgments 33 

Tables 

Table 1: Selected TRS Eligibility Criteria and Premiums for 

Selected Reservists as of October 1, 2006 10 

Table 2: TRICARE Options Available to Reservists and Their 

Dependents 12

Figures 

Figure 1: Periods of TRICARE Eligibility for Mobilized Reservists 

and their Dependents, as of July 2006 9 

Page i GAO-07-195 TRICARE Education for Reservists
Figure 2: Sources of Reservists’ and Their Dependents’ Health

Insurance, Prior to Mobilization, 2003 14 

Figure 3: Reservists’ Knowledge about Various Aspects of 

TRICARE 18

Figure 4: Comparison of Specific Aspects of Reservists’ TRICARE 

Health Insurance to Civilian Health Insurance 23 

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Page ii GAO-07-195 TRICARE Education for Reservists
United States Government Accountability Office

Washington, DC 20548 

February 12, 2007 

The Honorable Carl Levin 

Chairman 

The Honorable John McCain 

Ranking Minority Member 

Committee on Armed Services 

United States Senate 

The Honorable Ike Skelton 

Chairman 

The Honorable Duncan L. Hunter 

Ranking Minority Member 

Committee on Armed Services 

House of Representatives 

Since the September 11, 2001, terrorist attacks, the Department of Defense 

(DOD) has increased its reliance on reservists to support the global war on

terrorism, and particularly Operations Enduring Freedom and Iraqi 

Freedom.1,2

 This has increased the number of reservists supporting DOD’s 

current operations and the duration of reservists’ active-duty service. In 

recent years, Congress has increased the health care benefits available to 

mobilized reservists and their dependents, which generally include family 

members such as spouses and dependent children. Although all activeduty military personnel must enroll in TRICARE, the military health 

insurance program, reservists and their dependents have historically been 

eligible for TRICARE only while the reservist was serving on active duty 

for an extended period of time following mobilization.3

 The National 

 1

For the purposes of this report, the term reservist includes all members of the seven 

reserve components. These reserve components are the Army National Guard and the Air 

National Guard, as well as the Army Reserve, the Naval Reserve, the Marine Corps Reserve,

the Air Force Reserve, and the Coast Guard Reserve. 

2

Operation Enduring Freedom, which began in October 2001, supports combat operations 

in Afghanistan and other locations, and Operation Iraqi Freedom, which began in March

2003, supports combat operations in Iraq and other locations. 

3

Mobilization is the process by which the armed forces are brought into a state of readiness 

for war or national emergency or to support some other operational mission. In this report, 

we use the term mobilization to refer to the process of calling up reserve components for 

active-duty service. We use the term mobilized reservist to refer to a reservist that has 

received his or her order to active duty. 

Page 1 GAO-07-195 TRICARE Education for Reservists
Defense Authorization Acts (NDAA) for Fiscal Years 2004, 2005, 2006, and 

2007 expanded the number of reservists and their dependents who are 

eligible for TRICARE, and the duration of their eligibility. These 

expansions in eligibility increased the number of reservists that DOD, 

working through the reserve components, is required to educate about 

TRICARE. Reservists who are mobilized for a period of more than 30 days

become eligible for TRICARE, as do their dependents. Those who have 

private health insurance that covers their dependents may choose to 

cancel that coverage and switch to TRICARE or continue that coverage. 

The increased dependence on reservists in recent years has raised 

questions by some members of Congress as to whether reservists and their 

dependents have adequate health insurance when they are not on active 

duty and whether they have difficulty using TRICARE when they are 

eligible for it. The NDAA for Fiscal Year 2004 directed that we study the 

health insurance coverage of reservists and their dependents, DOD’s 

efforts to provide assistance specifically to reservists and their dependents 

to facilitate their access to and use of TRICARE benefits, and reservists’ 

and their dependents’ experiences using TRICARE.4

 Specifically, as 

discussed with the committees of jurisdiction, we (1) identified the extent 

to which reservists have civilian health insurance, (2) examined DOD’s 

efforts to educate reservists and their dependents about TRICARE, and 

(3) described reservists’ level of satisfaction with TRICARE and the types 

of problems reservists and their dependents experienced when using 

TRICARE. 

To determine the extent to which reservists have civilian health insurance 

coverage, we relied on the results of DOD’s 2003 and 2004 Status of Forces 

Surveys of Reserve Component Members, the most recent surveys that 

include questions about reservists’ insurance coverage.5

 Through our 

review of the relevant documentation and our discussion with DOD 

officials, we determined that the data presented in the surveys were 

sufficiently reliable for our purposes. We interviewed representatives from

 4

Pub. L. No. 108-136, § 705, 117 Stat. 1392, 1528-29 (2003). 

5

The Status of Forces Surveys are a series of surveys of reserve and active-duty personnel

that provide DOD with information for evaluating and monitoring existing programs and 

policies. Each year, the Status of Forces Survey includes different questions covering

different issues. The 2003 and 2004 surveys each asked reservists a different set of healthrelated questions. We did not use the 2005 Status of Forces Survey because it did not

contain any health-related questions. The 2006 Survey was not available when we 

performed this work. 

Page 2 GAO-07-195 TRICARE Education for Reservists
DOD’s Office of Reserve Affairs, the TRICARE Management Activity 

(TMA), Defense Manpower Data Center, and each of the seven reserve 

components. We also reviewed reports from the Congressional Research 

Service and Congressional Budget Office as well as GAO’s prior work on 

reservists and defense health care. 

To examine DOD’s efforts to educate reservists and their dependents 

about TRICARE and to describe reservists’ level of satisfaction with 

TRICARE and the types of problems reservists and their dependents 

experienced when using TRICARE, we interviewed over 100 reservists 

from the Army National Guard and Navy Reserve. We selected these two 

groups because they had large numbers of reservists demobilizing that we 

were able to interview during the course of our work. We used these 

interviews to validate and update information that we gathered from 

DOD’s 2003 and 2004 Status of Forces Surveys of Reserve Component 

Members, the 2002 Survey of Spouses of Activated National Guard and 

Reserve Component Members, and the 2000 Survey of Reserve Component 

Members. We also developed and conducted our own survey of TRICARE 

benefit counseling and assistance coordinators (BCAC). With the 

assistance of DOD officials, we identified BCACs who had direct 

experience providing TRICARE counseling and assistance to reservists 

and their dependents. DOD officials said that because BCACs assist 

reservists and their dependents with problems using TRICARE, they could 

provide us with perspective on the types of problems that reservists 

experience.

For a complete discussion of our scope and methodology, see appendix I.

We conducted our work from October 2005 through December 2006 in 

accordance with generally accepted government auditing standards. 

Most reservists have civilian health insurance and many of them choose to 

maintain this insurance for their dependents during mobilizations. Prior to 

being mobilized, 80 percent of reservists had civilian health insurance—a 

rate similar to that of comparable groups within the U.S. population 

between 18 and 64 years old. Reservists higher in age and rank are more 

likely to have health insurance than their junior counterparts. Reservists 

with dependents are also more likely to have insurance than those that do

not have dependents. Reservists obtained coverage through a variety of 

sources, and some reservists had more than one source of coverage. The 

most common sources of health insurance were the reservists’ employerbased health plans and their spouses’ employer-based health plans. Over 

half of all reservists kept their civilian health insurance for their 

Results in Brief 

Page 3 GAO-07-195 TRICARE Education for Reservists
dependents during their most recent mobilizations, even though they were

eligible to receive coverage under TRICARE with no associated premiums.

DOD is challenged by the task of educating reservists and their 

dependents about TRICARE, and many reservists and dependents 

consider themselves to be ill-informed about it. Increased mobilizations of 

reservists and successive legislative changes that have increased 

reservists’ eligibility for TRICARE have complicated DOD’s efforts to 

educate reservists about TRICARE. According to the 2003 Status of Forces 

Survey, fewer than 20 percent of all reservists said that they and their 

dependents are well informed about TRICARE. In the 2004 Survey, 

approximately 41 percent of reservists reported that their dependents did 

not use TRICARE because of its complexity. Fifty-eight percent of 

TRICARE BCACs that responded to our survey said that reservists’ ability 

to understand TRICARE is the biggest problem they face. DOD’s primary 

educational tools are TRICARE briefings provided to reservists at 

mobilization sites just prior to being deployed to the location of their 

active-duty service, and at demobilization sites when they return. These 

briefings are supplemented by family support programs, Web sites, tollfree customer assistance numbers, and print materials. TRICARE officials 

have noted that education could be improved for reservists by providing 

additional TRICARE briefings at times when reservists are not being 

mobilized or demobilized because reservists are distracted by other 

concerns during these times. They have also suggested targeting additional 

TRICARE education to dependents. DOD officials recognize the need to 

improve TRICARE education, but do not plan to provide additional 

TRICARE briefings for reservists and their dependents. 

A majority of reservists report that they are satisfied with their TRICARE 

benefits; however, some reservists have experienced difficulties when 

using TRICARE. When we interviewed reservists, over half reported 

satisfaction with TRICARE, which was consistent with data from DOD’s 

2003 Status of Forces Survey in which over 60 percent of the reservists 

who used TRICARE reported being satisfied with it. Additionally, the 2004 

Status of Forces Survey showed that 70 percent of reservists thought 

TRICARE was either equal to or better than their civilian health insurance. 

However, the survey also showed that when reservists and their 

dependents experienced problems related to TRICARE, among the most 

commonly reported difficulties was a general lack of understanding about 

TRICARE. Other difficulties included establishing TRICARE eligibility, 

obtaining TRICARE assistance, and finding a health care provider that 

accepts TRICARE. DOD officials we interviewed said they believed that 

some of these difficulties stemmed from problems with the recording of 

Page 4 GAO-07-195 TRICARE Education for Reservists
reservists’ eligibility for TRICARE, which is done by reserve component 

administrative personnel rather than TMA personnel. Therefore, a 

reservist who was not properly registered in DOD’s system for recording 

eligibility might seek assistance from a TRICARE BCAC, who would be 

unable to assist the reservist with his or her problem, rather than the 

administrative personnel who could assist with such problems. 

In light of the increasing number of reservists that are eligible for 

TRICARE, and reservists’ continued concerns that they are ill-informed 

about TRICARE, we recommend that the Secretary of Defense improve 

TRICARE education for reservists and their dependents by providing 

additional TRICARE briefings at times other than at mobilization and 

demobilization, or at the time that reservists are first informed of their 

impending mobilization. In commenting on this recommendation, DOD 

agreed that TRICARE information should be provided to reservists and 

their dependents when they are first informed of a pending mobilization of 

the member; however, it disagreed that TRICARE briefings should be 

provided at other times. DOD stated that training time is limited during 

training periods not associated with mobilization and must be prioritized 

to maximize its value. We understand the importance for DOD to 

effectively use limited training time. However, we continue to believe that

providing TRICARE briefings whenever time becomes available during 

reservist training periods—a time when reservists are not distracted by 

other concerns associated with mobilization—would be an effective way 

to help ensure that reservists are aware of the most current information 

about TRICARE. 

Since the end of the cold war, there has been a change in the way reserve 

forces have been used in military operations. During the cold war era, the 

reserve components were a manpower tool that was rarely tapped. For 

example, from 1945 to 1989, reservists were mobilized by the federal 

government only four times, an average of less than once per decade.

Since 1990, reservists have been mobilized by the federal government six 

times, an average of nearly once every 3 years, and have been used 

extensively to support operations in the global war on terrorism. Since 

September 11, 2001, about 500,000 reservists have been mobilized, 

Background 

Page 5 GAO-07-195 TRICARE Education for Reservists
primarily to support operations in Afghanistan and Iraq.6

 This increased 

use of the reserves has led to greater congressional interest in the types of

benefits provided to reservists, including the health insurance provided to

reservists and their dependents under TRICARE. Specifically, advocates 

for expanding TRICARE have suggested that increasing reservists’ access 

to TRICARE could improve the medical readiness of reservists by 

facilitating early detection and treatment of medical conditions which 

otherwise might disqualify a reservist from deploying. Additionally, 

increased access to TRICARE could smooth the transition to and from 

active duty for reservists and their dependents, an important factor given 

the increased mobilizations of reservists. 

Health Insurance 

Protections for Reservists 

Reservists’ private health insurance coverage is protected by the 

Servicemembers Civil Relief Act (SCRA)7

 and the Uniformed Services 

Employment and Reemployment Rights Act of 1994 (USERRA).8

 Included

in these acts are protections for reinstating and maintaining reservists’ 

health insurance. Specifically, when a reservist whose individual coverage

was terminated while the reservist was on active duty returns from that 

duty, SCRA requires private insurance companies to reinstate coverage at 

the premium rate the reservist would have been paying had coverage not 

been terminated.9

 It also requires insurance companies to cover most 

preexisting conditions after a reservist’s insurance is reinstated.10 USERRA 

allows reservists to elect to keep employer-provided health benefits while 

 6

In 2005, 88 percent of reservists were a part of the Selected Reserve, which is one category 

of reservists. The Selected Reserve contains those units and individuals considered 

essential to wartime missions. The other reserve categories are the Individual Ready

Reserve, the Inactive National Guard, Standby Reserve, and Retired Reserve. 

7

Pub. L. No. 108-189, 117 Stat. 2835 (2003) (codified at 50 U.S.C. App. §§ 501-596). National 

Guard members are eligible for SCRA protection only when they have been called to active

duty for more than 30 days to respond to a national emergency declared by the President 

and that active duty is supported by federal funds. 

8

Pub. L. No. 103-353, 108 Stat. 3149 (codified as amended at 38 U.S.C. §§ 4301-4334). 

9

The reservist’s individual insurance premium may be increased during the period between 

termination and reinstatement, but only to the extent it would have been increased for 

other persons covered by that insurance during that period. 

10Preexisting conditions that are service connected are excluded from coverage. For 

example, individual policies would not have to cover injuries incurred in the line of duty

that could be covered first by DOD and then by the Department of Veterans Affairs. In

addition, preexisting conditions excluded during the original period of coverage may also

be excluded after reinstatement. 

Page 6 GAO-07-195 TRICARE Education for Reservists
the reservists are absent from employment due to active duty, up to a 

maximum period of 24 months. For absences of 30 days or less, the 

employer must continue to pay its share of the premium. For absences of 

31 days or more, the reservist may elect to continue the civilian coverage, 

but the employer may charge the reservist the full premium, including the 

employer contributions.11 In addition, under USERRA, employers must 

generally reinstate reservists’ health coverage upon their reemployment 

and no waiting period or exclusions may be imposed in connection with 

that reinstatement.12 The protections found in SCRA and USERRA also 

apply to the health benefits of a reservist’s dependents, if those 

dependents were covered under the reservist’s policy prior to his or her 

active-duty service. 

Expanded TRICARE 

Eligibility for Reservists 

and Their Dependents 

Prior to fiscal year 2004, reservists that were not on active duty had limited 

eligibility for TRICARE. Specifically, they were entitled to receive 

treatment through TRICARE at a military medical facility for illnesses or 

injuries incurred during training or periods of active duty. Family members 

of reservists had generally not been entitled to use TRICARE, but became 

eligible if the reservist was serving on active duty for more than 30 days.

Beginning in fiscal year 2004, Congress made successive changes to 

TRICARE that included several provisions which significantly expanded 

access to TRICARE for reservists that are not on active duty, and their 

dependents. (For a detailed description of the legislative changes that 

expanded the TRICARE eligibility of reservists, see app. II.) The NDAA for 

Fiscal Year 200413 included a temporary provision in which Congress 

authorized members of the Selected Reserve and the Individual Ready

Reserve to enroll in TRICARE if the reservists were eligible for 

unemployment compensation or ineligible for health care coverage from 

 11For deployments of 31 days or more, USERRA permits the employer to assess an 

additional 2 percent administrative fee if reservists elect to continue with civilian insurance 

and pay the full premium, including the employer share. The employer is not required to

charge the full premium or the 2 percent administrative fee and some employers continue 

to pay some or all of the premium during the reservist’s absence. 

12Waiting periods or exclusions are permitted in cases where they would have been in 

effect had coverage not been interrupted by the reservist’s absence and in cases where the 

illness or injury has been incurred during or aggravated by the reservist’s service. 

13Pub. L. No. 108-136, 117 Stat. 1392 (2003). 

Page 7 GAO-07-195 TRICARE Education for Reservists
their civilian employer.14 Another temporary provision allowed reservists 

who had received their active-duty orders to use TRICARE for up to 

90 days before their active-duty service began. A third temporary provision 

extended the length of time that service members could use TRICARE 

under the Transitional Assistance Management Program (TAMP) to 

180 days after they were released from active duty.15

The NDAA for Fiscal Year 200516 indefinitely extended the provisions that 

provided up to 90 days of TRICARE coverage to reservists prior to the 

beginning of active-duty service and 180 days after.17 It also authorized the 

program that DOD has named TRICARE Reserve Select (TRS), which 

makes TRICARE coverage available for purchase by certain reservists 

after their TAMP coverage ends. As originally authorized, TRS provided 

the option of purchasing TRICARE coverage to members of the Selected 

Reserve who were mobilized since September 11, 2001, and who 

continuously served on active duty for 90 days or more in support of a 

contingency operation.18 To qualify for TRS, reservists had to enter into an 

agreement with their respective reserve components to serve in the

Selected Reserve for the number of years that they wished to participate in

TRS. They could receive 1 year of coverage for each 90-day period of this 

qualifying service.19 Electing to enroll in this TRS program was a one-time 

opportunity, and as originally authorized, the program required reservists 

to sign the new service agreement and register for TRS before leaving

 14We use the term temporary provision to refer to statutory requirements that are effective 

for a limited amount of time or have a set expiration date. 

15These three temporary provisions expired on December 31, 2004. 

16Pub. L. No. 108-375, 118 Stat. 1811 (2004). 

17Both the preactive-duty benefit and TAMP coverage are also available for dependents of 

the reservists. See 32 C.F.R. §§ 199.3(b)(5) and 199.3(e). 

18A contingency operation is generally defined as an operation designated by DOD as one in 

which members of the armed forces are or may become involved in military actions against 

an enemy of the United States or against an opposing military force, or an operation that 

results in the call to active duty of members of the uniformed services under any applicable 

provision of law during a war or national emergency declared by the President or Congress.

See 10 U.S.C. § 101(a)(13). Examples of contingency operations include Operations 

Enduring Freedom and Iraqi Freedom. 

19Reservists who were ordered to active duty for a period of more than 30 days, but served

less than 90 continuous days due to an injury, illness, or disease incurred or aggravated 

while deployed, were eligible for 1 year of TRICARE coverage under TRS as originally 

authorized.

Page 8 GAO-07-195 TRICARE Education for Reservists
active duty.20 Figure 1 describes the various periods of TRICARE eligibility 

for mobilized reservists and their dependents. 

Figure 1: Periods of TRICARE Eligibility for Mobilized Reservists and their Dependents, as of July 2006 

Source: GAO. 

 

 

 

Reservist’s eligibility 

Qualifying dependent’s eligibility 

TRICARE

during active dutya

An average of

371 days

Preactive

duty

benefit

Up to 

90 days

TAMP 

180 

days

TRS

Coverage limited to 1 year of coverage 

for each 90-day period of qualifying service

active-duty order

active duty begins

active duty ends

Eligibleb for coverage If eligible, coverage may be purchased 

Eligible for coverage If reservist is eligible, coverage may be purchased 

a

For a reservist to qualify for TRICARE, the active-duty order must be for a period of over 30 days. 

b

The reserve component will validate eligibility.

The NDAA for Fiscal Year 200621 further expanded the number of 

reservists and dependents eligible to participate in the TRS program. 

Under the expanded program, which became effective on October 1, 2006,

almost all reservists and dependents—regardless of the reservist’s prior 

active-duty service—have the option of purchasing TRICARE coverage. 

Similar to the original TRS program, members of the Selected Reserve and 

dependents choosing to enroll in the expanded TRS program must pay a 

monthly premium to receive TRICARE coverage. The premium paid by 

 20Reservists who qualified could also obtain coverage for their dependents by paying the 

appropriate premium. 

21Pub. L. No. 109-163, 119 Stat. 3136 (2006). 

Page 9 GAO-07-195 TRICARE Education for Reservists
reservists and their dependents for coverage varies based on certain 

qualifying conditions that must be met, such as whether the reservist has 

access to an employer-sponsored health plan. Those who would have been 

eligible under the original TRS program because they have qualifying 

service in support of a contingency operation pay the lowest premium. In

addition, those reservists with qualifying service in support of a 

contingency operation would now have up to 90 days after leaving active 

duty to sign the new service agreement required to be eligible for this 

lowest premium tier. Table 1 describes the Selected Reservists who are 

eligible to purchase TRS and the associated premiums. 

Table 1: Selected TRS Eligibility Criteria and Premiums for Selected Reservists as of October 1, 2006 

Monthly TRICARE premium cost for 

calendar year 2006b

Eligibility criteria 

Percentage of

TRICARE 

premium paid by 

the reservista

TRS member only TRS member and family Duration of coverage 

Tier 1: Reservist must have 

qualifying active-duty service in

support of a contingency operation 

on or after September 11, 2001, for 

at least 90 days, and must maintain 

Selected Reservec

 status for each 

year of TRS coverage purchased. 

28 $81.00 $253.00 1 year of coverage for 

each continuous 90 days 

of qualifying service. 

Tier 2: Reservist must not be eligible 

for employer-sponsored health 

insurance; or must be eligible for 

unemployment compensation, or 

self-employed; must renew service 

agreement and maintain Selected 

Reserve status for each year of TRS 

coverage purchased. 

50 $145.29 $451.42 Up to 1 year of coverage

with an annual option to 

renew. 

Tier 3: Reservist not eligible for Tier 

1 or 2; may be eligible for employersponsored insurance, but must

renew service agreement and

maintain Selected Reserve status 

for each year of TRS coverage 

purchased. 

85 $247.00 $767.41 Up to 1 year of coverage

with an annual option to 

renew. 

Source: GAO.

a

The total amount of the premium is the amount determined by the Secretary of Defense for Health 

Affairs, based on an appropriate actuarial basis. 

b

DOD plans to recalculate the monthly premiums annually. 

c

The Selected Reserve component contains those units and individuals considered essential to 

wartime missions. In 2005, 88 percent of reservists were a part of the Selected Reserve. 

Page 10 GAO-07-195 TRICARE Education for Reservists
The NDAA for Fiscal Year 2007 significantly restructured the TRS program 

by eliminating the three-tiered premium structure.22 This law provides that 

members of the Selected Reserve will be eligible to purchase TRICARE 

coverage for themselves and their dependents at the 28 percent premium 

rate regardless of whether they have served on active duty in support of a 

contingency operation.23 In addition, eligibility at the 28 percent premium 

rate will not depend on the length of a service agreement entered into 

following a period of active-duty service. Instead, reservists will be eligible 

for TRS for the duration of their service in the Selected Reserve. The law 

requires DOD to implement these changes no later than October 1, 2007. 

In order to use TRICARE, reservists must establish their own and their 

dependents’ eligibility in the Defense Enrollment Eligibility Reporting 

System (DEERS)—the computerized database which DOD uses to store 

the identity of active-duty members and reservists, and their dependents. 

Proper registration in DEERS is necessary to use TRICARE. Reservists are 

automatically registered in DEERS by reserve component administrative 

personnel, but reservists must register their dependents and ensure that 

those dependents are correctly entered into the database. Although 

TRICARE is administered by TMA, reserve components’ administrative 

personnel record reservists’ enrollment in DEERS and resolve any DEERSrelated problems. 

Once determined to be eligible for TRICARE, mobilized reservists and 

their dependents are able to choose among several TRICARE options. 

These beneficiaries may obtain health care through DOD’s direct care 

system of military hospitals and clinics, commonly referred to as military 

treatment facilities (MTF), or through DOD’s system of civilian providers. 

DOD uses managed care support contractors to develop networks of 

civilian providers to complement the care available in MTFs. Upon arriving 

at their final duty station, mobilized reservists must enroll in TRICARE 

Prime, TRICARE’s managed care option. Their dependents may enroll in 

TRICARE Prime. If they do not enroll in TRICARE Prime, they may receive 

care through TRICARE Standard, TRICARE’s fee-for-service option, or 

Defense Enrollment 

Eligibility Reporting 

System 

TRICARE Options for 

Mobilized Reservists and 

Their Dependents 

 22See Pub. L. No. 109-364, § 706, 120 Stat. 2083, (to be codified at 10 U.S.C. § 1076(d)). 

23The law lists one exception. Members of the Selected Reserve who are eligible for 

coverage under the Federal Employees Health Benefit Plan will not be eligible to purchase

TRICARE for themselves or for their dependents. 

Page 11 GAO-07-195 TRICARE Education for Reservists
TRICARE Extra, TRICARE’s preferred provider option. While all 

beneficiaries may receive care on a space-available basis at MTFs, 

TRICARE Prime enrollees have priority for care at these facilities. Under 

TRICARE, the dependents of mobilized reservists do not pay premiums for 

their health care coverage; however, depending on the option chosen, they 

may be responsible for co-payments and deductibles. Table 2 provides an

overview of these options. 

Table 2: TRICARE Options Available to Reservists and Their Dependents 

TRICARE plan 

option Providersa

Copayments 

Yearly 

deductible

Prime 

(managed care) 

Network providers None None 

Extra 

(preferred provider) 

Network providers 15 percent of 

negotiated rateb

 

Annual 

deductibles may 

apply 

Standard 

(fee-for-service) 

Non-network providers 

who will accept TRICARE 

rates 

20 percent of 

allowable chargec

Annual 

deductibles may 

apply 

Source: GAO analysis of TRICARE Web data. 

a

All beneficiaries may receive care at MTFs as space and capabilities are available, but TRICARE 

Prime enrollees have priority for care in MTFs. 

b

A negotiated rate is the rate that TRICARE has agreed to pay the preferred provider.

c

An allowable charge is the maximum amount TRICARE is allowed to authorize for each procedure or 

service and is tied by law to Medicare’s allowable charges. See 10 U.S.C. § 1079(h). Non-network 

providers are prohibited from billing beneficiaries more than 115 percent of the TRICARE allowable 

charge for a given procedure or service. 

Most reservists have civilian health insurance, and over half of all 

reservists choose to maintain their civilian health insurance during 

mobilization. Prior to being mobilized, 80 percent of reservists had civilian 

health insurance—a rate which is similar to that of the U.S. population 

between 18 and 64 years old. Insurance coverage varies by rank and age, 

with officers and senior personnel more likely to have coverage than 

junior personnel. Reservists with dependents are also more likely to have 

coverage than those that do not have dependents. Reservists obtained 

coverage through a variety of sources, and some reservists had more than 

one source of coverage. Even when reservists were mobilized and eligible

for TRICARE, over half opted to keep their civilian health insurance for 

their dependents during their most recent mobilization. As of December 

2006, less than 3 percent of eligible reservists had opted to enroll in TRS. 

Most Reservists Have 

Civilian Health 

Insurance, and Many 

Reservists Choose to 

Maintain Their 

Civilian Insurance 

When Mobilized 

Page 12 GAO-07-195 TRICARE Education for Reservists
The percentage of reservists with health insurance—80 percent—is similar 

to that of the U.S. population between 18 and 64 years old. Insurance 

coverage for reservists varies by rank and age. According to the 2003 

Status of Forces Survey, officers and senior-enlisted reservists were more

likely to have health insurance than junior-enlisted personnel. Ninety-one 

percent of officers and 87 percent of senior-enlisted personnel, both of 

whom have an average age of over 37 years, reported having health 

insurance; 67 percent of junior-enlisted reservists, with an average age of 

25 years, reported having health insurance.24

Reservists Covered by 

Health Insurance at Rates 

Similar to Those Found in 

the General Population 

Insurance coverage for reservists also varies between those with 

dependents and those without dependents. For example, 87 percent of 

reservists with dependents reported having civilian health insurance prior

to their most recent activation, while only 65 percent of reservists without 

dependents reported having civilian health insurance. Similarly, 91 percent 

of senior-enlisted reservists with dependents had such insurance prior to 

their most recent mobilization, compared with 70 percent of seniorenlisted personnel without dependents. 

The percentage of reservists with health insurance has remained relatively

consistent over time. In prior work we reported that in 2000, nearly 

80 percent of all reservists had health insurance, and 60 percent of junior

enlisted reservists had health insurance. Eighty-six percent of reservists 

with dependents had health insurance and 63 percent of reservists without 

dependents reported having insurance.25 Within the general population, 

there has been a slight decrease in the number of individuals with health 

insurance over the past 6 years: In 2000, 82 percent of the 18 to 64 year old 

population had health insurance, as compared with 80 percent in 2005. 

Reservists and their dependents obtained health insurance through a 

variety of sources, and some had more than one source of insurance 

coverage. Figure 2 shows the sources of reservists’ and their dependents’ 

health insurance prior to mobilization. The primary source of health 

 24Age data provided by DOD as of October 2006. DOD categorizes enlisted personnel as 

either junior enlisted (classified as E-1 to E-4) or senior enlisted (classified as E-5 to E-9). 

The average age of junior-enlisted Selected Reservists is 25 years old; the average age of 

senior-enlisted Selected Reservists is 37 years old. The average age for officers in Selected 

Reserve status is 39 years old. 

25GAO, Defense Health Care: Most Reservists Have Civilian Health Coverage but More

Assistance Is Needed When TRICARE Is Used, GAO-02-829 (Washington, D.C.: Sept. 6,

2002). 

Page 13 GAO-07-195 TRICARE Education for Reservists
insurance was civilian employers. About three-quarters of reservists and 

their dependents were covered by their civilian employers’ health plan, 

and over one-quarter were also covered by their spouses’ civilian 

employer’s health plan.

Figure 2: Sources of Reservists’ and Their Dependents’ Health Insurance, Prior to Mobilization, 2003 

2

5

8

10

28

74

0 10 20 30 40 50 60 70 80

School's health insurance plan

Spouse's/ family member's active duty/

retired military health coverage

Veterans (VA) coverage

Other private coverage

Spouse's/family member's civilian

employer's health insurance plan

Reservist's civilian employer's

health insurance plan

Source: DOD's 2003 Status of Forces Survey.

Percentage

Sources of health insurance

Note: Margin of error within ± 2 percent. 

Percentages total more than 100 because some survey respondents reported more than one source 

of health insurance for themselves or their dependents. 

Many Mobilized Reservists 

Choose to Maintain

Civilian Coverage 

Although reservists are required to enroll in TRICARE and their 

dependents become eligible for TRICARE when the reservists are 

mobilized, most opt to maintain their civilian insurance for their 

dependents during their active-duty service. According to the 2003 Status 

of Forces Survey, 52 percent of reservists maintained their civilian 

employer’s health insurance during their most recent mobilization. The 

2004 Status of Forces Survey found that 85 percent of reservists reported 

that their civilian employer continued to pay at least a portion of their 

insurance premium. According to the survey and our interviews with DOD 

officials, many reservists maintained their civilian health insurance to 

Page 14 GAO-07-195 TRICARE Education for Reservists
avoid disruptions associated with changing to TRICARE and to ensure that 

their dependents could continue seeing their current providers who may 

not accept TRICARE. 

Relatively Few Reservists 

Have Enrolled in TRS 

On April 27, 2005, TRS became available to certain reservists returning 

from active duty on contingency operations. In October 2006, TRS became 

available to an expanded number of reservists based upon their health 

insurance status. As of December 2006, less than 3 percent of eligible 

reservists had enrolled in TRS. DOD officials reported that more than 

485,000 reservists were eligible to enroll in TRS, and as of December 2006,

over 11,000 reservists had enrolled themselves or their dependents in 

TRS.26 DOD officials said that one reason for the low enrollment rate may 

be the result of an enrollment process which, until passage of the NDAA 

for Fiscal Year 2006, required reservists to take the first step toward 

enrollment while they were still on active duty. To become eligible to 

purchase coverage in TRS, a reservist had to execute a service agreement 

to remain in Selected Reserve status while still serving on active duty. This

usually occurred at a demobilization site. Officials told us that they believe 

that a primary reason that reservists did not take this first step in the 

enrollment process was that reservists were generally more focused on 

returning to their families during this period than they were on making 

decisions about their health insurance. The NDAA for Fiscal Year 2006 

changed this requirement so that reservists have up to 90 days from the 

end of their active-duty service to execute the service agreement and the 

length of the agreement determines the time period of their eligibility for 

TRS at the 28 percent premium. The NDAA for Fiscal Year 2007 eliminated

the service agreement requirement and, under this law, eligibility for TRS 

will end only upon the termination of the reservist’s service in the Selected 

Reserve. Finally, some DOD officials said that a lack of education about 

the program may also have resulted in low participation rates.

 26As of the end of April 2006, over 485,000 reservists had been mobilized for a contingency 

operation. About 19 percent have served more than once. 

Page 15 GAO-07-195 TRICARE Education for Reservists
The increased number of reservists being mobilized and changing 

TRICARE eligibility requirements for reservists have challenged DOD in its 

efforts to educate reservists and their dependents about TRICARE. 

Reservists have reported that they and their dependents are not well 

informed about TRICARE, with less than 20 percent saying they were well

informed. The primary educational resources DOD relies on are the 

TRICARE briefings provided by each reserve component to mobilized 

reservists just prior to deployment, and those given at demobilization sites 

when reservists return from deployment. These briefings are 

supplemented by family support programs, Web sites, toll-free customer 

assistance numbers, and print materials. DOD officials said that education 

could be improved for reservists and their dependents by providing 

TRICARE briefings to reservists at times not associated with mobilization 

or demobilization, targeting TRICARE education for dependents, and 

improving other existing educational resources. DOD has worked to 

improve several of its tools for educating reservists about TRICARE, but it 

currently has no plans to require that the reserve components provide 

additional TRICARE briefings. 

Increased mobilizations of reservists and continuing changes to TRICARE

eligibility have increased the number of reservists and dependents that 

DOD must educate about TRICARE. The terrorist attacks of September 11, 

2001, marked the beginning of a substantial increase in the number of 

reservists being mobilized and therefore eligible for TRICARE. From 1996 

to 2001, DOD provided TRICARE education to approximately 10,000 

mobilized reservists annually. Since the beginning of fiscal year 2002, DOD 

has provided TRICARE education to about 125,000 mobilized reservists 

annually, according to DOD officials. 

DOD Is Challenged by 

the Task of Educating 

Reservists and Their 

Dependents about 

TRICARE 

DOD Is Educating an 

Increased Number of 

Reservists and Dependents 

about TRICARE 

Steadily expanding TRICARE eligibility for reservists has also placed new 

challenges on DOD to continually update its educational programs. These 

expansions (described in app. II) have required DOD to revise its training 

materials, update its Web site, and retrain benefits counseling and 

assistance coordinators to provide more current information to reservists 

and their dependents. For example, the pre-active duty benefits discussed 

earlier were expanded, from 30 days to up to 90 days prior to the date 

active-duty service begins. TAMP, which provides continued TRICARE 

coverage to reservists separating from active duty, was extended from 

60 days to 180 days. In fiscal year 2005, with the initial implementation of 

TRS, DOD developed new educational materials to inform reservists and 

their dependents of their new benefits. The NDAA for Fiscal Years 2006

and 2007 each revised the provisions of TRS. In response to these 

Page 16 GAO-07-195 TRICARE Education for Reservists
requirements, DOD updated its educational tools because the tools 

describing who is eligible, what premiums they pay, and when they must 

register changed with each revision.

Most Reservists and Their 

Dependents Are Not WellInformed about TRICARE 

Reservists reported that they and their dependents are not well informed

about TRICARE. TRICARE BCACs that responded to our survey in 2006 

reported that the most commonly experienced problem that reservists and 

their dependents face when using TRICARE is a poor understanding of the 

program. According to DOD’s 2003 Status of Forces Survey, the last time 

DOD surveyed reservists about their knowledge of TRICARE, less than 

20 percent of all reservists believed that they were well-informed about 

their TRICARE benefits. 

These findings are consistent with our past work on civilian health 

coverage of reservists and their dependents, and they indicate that DOD 

has been challenged by the task of educating reservists about TRICARE 

since at least 2000. In past work, we found that reservists and their 

dependents that had dropped their private health insurance for TRICARE 

reported problems understanding TRICARE. We concluded that they could 

benefit from improved TRICARE education.27 Figure 3 illustrates data from 

DOD’s 2003 Status of Forces Survey showing reservists’ opinions of how 

well-informed they felt about various aspects of TRICARE. Reservists’ two

most frequently cited areas of confusion included knowing which doctors 

participated in the TRICARE provider network, and which services are 

covered by TRICARE.28

 27GAO-02-829, p. 19. 

28In 2005, DOD consolidated its TRICARE regions from 12 to 3, with a similar reduction in 

the number of contractors responsible for maintaining the network of physicians in each 

region. We did not specifically assess the impact, if any, this has had on reservists but it 

represents one more change that TRICARE has faced in educating reservists about 

TRICARE. 

Page 17 GAO-07-195 TRICARE Education for Reservists
Figure 3: Reservists’ Knowledge about Various Aspects of TRICARE 

0 20 40 60 80 100

Well-informed

Somewhat informed

Not informed

Reservist's eligibility for the program

Reservist families' eligibility for the program

Enrollment process for reservist

TRICARE options

Enrollment process for reservists' family

Covered services

Provider network 48 38 14

44 41 15

43 38 19

43 39 18

39 40 21

38 40 21

32 45 23

Percentage

Reservists’ knowledge about TRICARE

Source: DOD's 2003 Status of Forces Survey.

Note: Margin of error within ± 2 percent. 

Surveys indicate a lack of awareness about DOD programs designed to 

assist family members in learning about and using TRICARE. DOD 

officials said that they were interested in reaching out to reservists’ 

dependents because they recognize that reservists’ dependents, 

specifically spouses, often play a major role in the family’s understanding 

and use of TRICARE. However, DOD’s 2000 Survey of Reserve Component 

Members indicated that fewer than 50 percent of the spouses of mobilized 

reservists were aware of the family support programs designed to assist 

them in understanding and using TRICARE. The 2002 survey showed that 

fewer than 10 percent of spouses used these programs. 

Page 18 GAO-07-195 TRICARE Education for Reservists
DOD relies on a several methods to educate reservists and their 

dependents about TRICARE. TRICARE briefings by each reservist’s 

reserve component are the primary tool DOD uses to educate reservists 

about TRICARE. The briefings generally occur when a reservist is 

mobilized and when the reservist returns from a mobilization. However, 

many DOD officials and TRICARE BCACs have said that this is not an 

ideal time for reservists to initially learn about TRICARE. According to 

DOD officials, these days of training are often so full of critical 

information that it is difficult for the reservist to absorb all of the details of

TRICARE. These briefings also occur at a time when a reservist may have 

already been eligible for TRICARE for up to 90 days without realizing it.29

Similarly at demobilization sites, where reservists are debriefed upon 

returning from theater, officials tell us that many reservists are focused on 

returning home to their families rather than learning the details of their 

TRICARE benefits. In addition, briefings at mobilization and 

demobilization sites typically do not include reservists’ dependents. 

DOD Uses a Variety of 

Tools to Educate 

Reservists and Their 

Dependents about 

TRICARE 

Family support programs designed to educate reservists’ dependents 

about TRICARE are used by most of the reserve components, including 

the National Guard, Air Force, Army, Navy, and the Marines. DOD officials 

said that these programs are important because reservists’ dependents 

often play a major role in understanding and using reservists’ TRICARE 

benefits. Family support programs are intended to increase knowledge 

about a variety of military benefits, including TRICARE. For example, the 

Air Force Reserve Command provides TRICARE information and 

assistance at family support offices. In order to provide the most current 

information to reservists and their dependents, personnel at these 

locations are educated regularly about new programs that affect reservists. 

Similarly, the National Guard Bureau has established family assistance 

centers that provide support for dependents of deployed soldiers in the 

National Guard and other reserve components, as well as assistance for 

demobilizing soldiers. However, reservists have reported a lack of 

awareness about these programs and fewer than 10 percent of reservists’ 

spouses said they took advantage of these programs. 

DOD relies on other educational resources such as the TRICARE Web site, 

toll-free customer assistance phone numbers, the use of BCACs, and print 

 29DOD officials said that while pre-active-duty benefits give reservists up to 90 days of

TRICARE coverage prior to the date their active duty begins, reservists are rarely given 

90 days notice of upcoming active duty. 

Page 19 GAO-07-195 TRICARE Education for Reservists
materials sent directly to reservists and their dependents. However, most 

of these resources are helpful only to reservists and their dependents that 

actively seek TRICARE information; they do not reach out to reservists 

that are not already pursuing the information. 

In a survey administered by DOD in 2005, a third of reservists cited the 

TRICARE Web site as their primary source of information when they seek 

assistance. However, DOD officials acknowledged that the site was 

cumbersome, with a satisfaction rate of less than 60 percent. DOD 

reported in January 2006 that its TRICARE Web site contained over 

538,000 pages of content and over 300 subsites.30

In DOD’s 2005 survey, close to 13 percent of reservists cited a preference 

for obtaining assistance from toll-free customer assistance numbers. 

However, as of December 2006, the TRICARE Web Site listed at least 25 

different toll-free customer assistance numbers. This doesn’t include any 

toll-free numbers that each reserve component might have available. This

large number of TRICARE customer service numbers confuses 

beneficiaries. TRICARE users ranked phone and electronic sources of 

information as the most difficult to use. DOD’s Communications and 

Customer Service Group acknowledged that such a multitude of customer 

assistance numbers is sometimes not helpful. 

Finally, less than 3 percent of reservists said that they rely on print 

materials such as newspapers and newsletters. Although DOD has updated 

some of its print materials with information about TRS, these materials are 

not reaching all reservists. DOD said that the reserve components’ 

administrative personnel update the file of reservists’ addresses in DEERS

when notified by the member, but incorrect addresses remain for 

approximately 10 percent of reservists. According to DOD officials, this 

results in approximately 10 percent of TRICARE mailings being returned 

to sender as misdirected mail. 

Individual reserve units also provide TRICARE education to their 

members. This is sometimes a reservist’s primary source of information 

about his or her TRICARE benefits. However, DOD officials said the 

quality of this information can vary greatly across units and depends 

largely on the individuals charged with providing the information. 

 30TRICARE Conference, “Military Medicine: Transforming the Future” (Washington, D.C.: 

Jan. 30-Feb. 2, 2006). 

Page 20 GAO-07-195 TRICARE Education for Reservists
DOD officials recognize that TRICARE education could be improved, but 

they currently do not plan to require that the reserve components provide 

additional TRICARE briefings. DOD officials have suggested that 

TRICARE education could be made more effective by supplementing the 

TRICARE briefings provided at mobilization and demobilization sites with

annual briefings during training periods when reservists are not being 

mobilized and are therefore better able to focus on the material covered in

the briefing. DOD officials said that briefings at mobilization sites are a 

logical time to remind reservists of their available TRICARE benefits, but

this is not the best time to expose reservists to TRICARE information for 

the first time. However, as of July 2006, DOD had no plans to require 

reserve components to increase the number of TRICARE briefings they 

provide to reservists or change the time that they provide them. 

DOD Officials Recognize 

the Need for Improved 

TRICARE Education 

Half of the TRICARE BCACs that responded to our survey said that 

education should be improved. Some suggested targeting additional 

education to dependents of mobilized reservists. Other DOD officials 

agreed and said that the spouses of reservists are generally responsible for 

the family’s health care decisions when the member is mobilized, so 

dependents should therefore be a focus of DOD’s educational efforts. 

However, DOD officials we interviewed noted that when dependents are 

invited to briefings they often do not attend. They said that publicizing 

information to families could be a challenge, but suggested that reservists 

and their families also bear some responsibility for being aware of these 

programs. 

In November 2006, DOD launched a redesigned TRICARE Web site and 

TMA has plans to reduce the number and redundancy of pages on the Web

site. DOD officials acknowledge that they have inaccurate addresses on 

file for some reservists. They continue to send reminders to reservists to 

keep the information in DEERS current, but they expect there will always 

be a number of incorrect addresses on file. 

Page 21 GAO-07-195 TRICARE Education for Reservists
A majority of reservists report that they are satisfied with their TRICARE 

benefits; however, some reservists have experienced difficulties when 

using TRICARE. According to our interviews with reservists and DOD’s 

most recently available data, over half of the reservists who used 

TRICARE were satisfied with it. Additionally, 70 percent of reservists 

thought that TRICARE was either equal to or better than their civilian 

health insurance. However, when reservists did experience problems with 

TRICARE, the most commonly reported difficulties were (1) a general lack 

of understanding about the TRICARE program, (2) establishing TRICARE 

eligibility, (3) obtaining TRICARE assistance, and (4) finding a health care 

provider. DOD officials said they believed that some of these problems 

stemmed from difficulties reservists encounter in establishing their 

eligibility in DEERS, which is done through reserve component 

administrative personnel. Registration in DEERS is necessary for 

reservists and their dependents to use TRICARE. The officials we 

interviewed observed that helping reservists understand their benefits, 

establishing reservists’ eligibility for TRICARE, and addressing specific 

concerns is complicated because responsibility for resolving problems is 

divided across organizational units. TRICARE is administered by TMA, but 

recording reservists’ eligibility in DEERS is managed by each reserve 

component’s administrative personnel. 

In our interviews with over 100 reservists, we found that over half 

reported that they were satisfied with their TRICARE benefit. This was 

also supported by DOD’s 2004 Status of Forces Survey, which showed that 

70 percent of reservists thought TRICARE was either equal to or better 

than their civilian health insurance plans. DOD’s 2003 Status of Forces 

Survey showed that over 60 percent of the reservists who used TRICARE 

reported being satisfied with their own TRICARE benefits and with their 

dependents’ TRICARE benefits. Only 20 percent of reservists reported 

dissatisfaction with the benefits in the 2003 Status of Forces Survey. 

Figure 4 illustrates how specific aspects of TRICARE compared with 

reservists’ civilian health insurance.

Most Reservists Are 

Satisfied with Their 

TRICARE Benefits, 

but Some Reservists 

Experience 

Difficulties Using 

TRICARE 

Most Reservists Are 

Satisfied with TRICARE 

Page 22 GAO-07-195 TRICARE Education for Reservists
Figure 4: Comparison of Specific Aspects of Reservists’ TRICARE Health Insurance to Civilian Health Insurance 

0 20 40 60 80 100

Obtaining assistance when 

questions or problems arise

Administrative requirements

Waiting time in clinic

Quality of care

Out-of-pocket costs of care

Availability of medical providers

Availability of specialist

Understanding benefits

Overall comparison

Percentage

Source: DOD's 2004 Status of Forces Survey.

Better in TRICARE

No difference

Better in civilian plans

Comparison of TRICARE to civilian health insurance

23 47 30

17 39 44

12 39 49

12 37 51

41 31 28

11 59 30

10 57 32

15 42 42

17 39 44

Note: Margin of error within ± 2 percent. 

Percentages may not total 100 due to rounding. 

Some Reservists and Their 

Dependents Experienced 

Difficulties When Using 

TRICARE 

Some reservists and their dependents experienced difficulties when they 

used TRICARE. Our surveys of BCACs and interviews with reservists and 

DOD officials indicated that when reservists experienced difficulties using 

TRICARE, the most common difficulties included a lack of knowledge 

about TRICARE benefits, problems establishing TRICARE eligibility, 

obtaining TRICARE assistance, and finding medical providers. These 

Page 23 GAO-07-195 TRICARE Education for Reservists
findings were consistent with data from DOD’s 2003 Status of Forces 

Survey. 

Fifty-eight percent of the TRICARE BCACs that responded to our survey 

reported that the biggest problem reservists and their dependents faced 

when using TRICARE is their ability to understand TRICARE. Many 

reservists and their dependents lack a basic understanding of TRICARE. 

According to the 2004 Status of Forces Survey, about 41 percent of 

reservists reported that their dependents did not use TRICARE insurance 

because of the complexity of TRICARE. Some BCACs said that reservists 

and their dependents continue to experience difficulties understanding the 

complexity of the various options, knowing which benefits are covered, 

understanding the referral process and authorizations required, and the 

changing enrollment requirements. For example, enrollment requirements 

change throughout the periods before, during, and after a reservist’s 

active-duty service. Dependents of reservists who have been ordered to 

active duty for a period of more than 30 consecutive days may enroll in

TRICARE Prime if they wish to be covered by that option. Dependents 

enrolled in TRICARE Prime must then re-enroll to continue TRICARE 

Prime coverage during their TAMP period when the reservist returns from 

active duty. However, dependents using TRICARE Extra and TRICARE 

Standard are not required to re-enroll to receive TAMP benefits. Access to 

TRICARE could be impaired if reservists and their dependents fail to 

adhere to the changing enrollment requirements. 

Understanding Benefits 

Establishing eligibility for TRICARE in the DEERS database—DOD’s 

computerized database used to record TRICARE eligibility—has been 

problematic for many reservists and their dependents. Almost half of the 

BCACs that responded to our survey said that the process for establishing 

TRICARE eligibility in DEERS needed to be improved. DEERS stores the 

identity of reservists, dependents, and others who are entitled to TRICARE 

benefits as well as their dates of eligibility. BCACs that we surveyed and

other DOD officials said that many reservists and their dependents are 

incorrectly entered into DEERS when the reservists are mobilized. When 

reservists return from a mobilization, they are required to update their 

status in DEERS and to keep their dependents’ information updated as 

well in order to receive the benefits for which they are eligible. Reservists 

sometimes do not do this. When DEERS is not properly updated, reservists 

or their dependents might be denied medical care, or be charged 

incorrectly for medical services. According to DOD officials we 

interviewed, dependents of active-duty members also have problems with 

DEERS, but these problems are accentuated for dependents of reservists 

because their eligibility status can change more frequently. 

Establishing Eligibility

Page 24 GAO-07-195 TRICARE Education for Reservists
DOD does not collect data on how many reservists and their dependents 

experience problems with the information entered into the DEERS 

system. However, DOD officials said that they believe that some of the 

problems reservists face in using TRICARE, including the other problems 

described in this report, stem from problems in their DEERS enrollment. 

This problem is exacerbated by the fact that BCACs and other TMA staff 

are not able to resolve reservists’ problems with DEERS because each 

reserve component’s administrative personnel, rather than TMA, record 

reservists’ eligibility information in DEERS. Reservists often do not realize 

that they need to seek assistance with DEERS from a different office than 

that from which they would seek benefits assistance. For example, a 

reservist who was not properly registered in DEERS might seek assistance 

from a TRICARE BCAC, who would be unable to assist the reservist with 

his or her problem, rather than the administrative personnel who could 

assist with these problems. 

Almost a third of the BCACs that responded to our survey said that many 

reservists and their dependents experience difficulties in obtaining 

TRICARE assistance when problems or questions about TRICARE arise. 

Many reservists do not have a designated TRICARE expert within their 

unit and are not aware of the many resources available to assist them with 

their TRICARE benefits. BCACs we surveyed also reported that when 

reservists call for information, sometimes even unit-designated TRICARE 

representatives are confused by reservists’ benefits and cannot answer 

beneficiary questions. Some BCACs responsible for assisting reservists in 

using TRICARE do not have access to DEERS and are therefore unable to

provide accurate information about TRICARE eligibility to reservists and 

their dependents. 

Finding Assistance 

Over a quarter of the BCACs that responded to our survey reported that 

finding a medical provider is one of the problems most commonly 

experienced by reservists and their dependents when using TRICARE 

benefits. Some DOD officials we spoke with also said that reservists and 

their dependents experience difficulties finding medical providers that 

accept TRICARE. However, other work we have done reviewing access to 

care for TRICARE beneficiaries indicates that there are a large number of 

TRICARE providers accepting new patients except where there are few 

practicing providers in general, such as in geographically remote areas.31

Finding Medical Providers 

 31GAO, Defense Health Care: Access to Care for Beneficiaries Who Have Not Enrolled in

TRICARE’s Managed Care Option, GAO-07-48 (Washington, D.C.: Dec. 22, 2006). 

Page 25 GAO-07-195 TRICARE Education for Reservists
We could not determine whether reservists that experienced difficulty 

finding TRICARE providers lived in geographically remote areas. 

Changes to reservists’ TRICARE eligibility have resulted in DOD having to

educate a growing number of reservists and their dependents about their 

eligibility requirements and benefits under TRICARE. Despite DOD’s use 

of a variety of tools to educate reservists about TRICARE, reservists, 

BCACs, and DOD officials continue to suggest that TRICARE education

could be improved by providing TRICARE briefings at times other than 

when reservists are being mobilized or returning from mobilizations. For 

example, reservists have other required training periods during the year 

where a discussion of TRICARE benefits could be a part of the program. In 

addition, while reservists and their dependents become eligible for 

TRICARE up to 90 days before the reservists’ active-duty service begins, 

they might not learn of this eligibility until the TRICARE briefing they 

receive at the mobilization site. Despite this shortcoming, DOD has no 

plans to add additional TRICARE briefings during times other than 

mobilization and demobilization. 

We recommend that the Assistant Secretary of Defense for Health Affairs 

improve TRICARE education for reservists and their dependents by 

providing additional TRICARE briefings to reservists and their 

dependents. These briefings could be provided to reservists during 

training periods not associated with mobilizations or at the time that 

reservists are first informed of their impending mobilization. 

DOD provided written comments on a draft of this report. DOD partially 

concurred with our recommendation, agreeing that information about 

TRICARE should be provided to reservists and their family members when

they are first informed of a pending mobilization of the member or any 

time a member is ordered to active duty or full-time National Guard duty 

for more than 30 days. However, DOD did not agree that providing 

additional briefings during periods not associated with mobilizations 

would be beneficial. DOD’s comments are reprinted in appendix III. 

Conclusions 

Recommendation 

Agency Comments 

and Our Evaluation 

DOD noted that reservists’ training time is limited and must be prioritized 

to maximize its value. DOD further noted the difficulty in holding the 

interest of an audience to describe a benefit for which they are not yet 

eligible. DOD stated that it has provided an abundance of information 

about TRICARE to reservists and their family members. 

Page 26 GAO-07-195 TRICARE Education for Reservists
As we noted earlier, DOD has revised its training materials and updated its 

Web site to provide more current information to reservists and their 

dependents. However, our surveys and interviews with BCACs and 

reservists indicate that these materials are not reaching all reservists, but 

instead reach only those that actively seek TRICARE information. 

Furthermore, we understand the importance for DOD to effectively use 

limited training time. However, we continue to believe that providing 

TRICARE briefings whenever time becomes available during reservist 

training periods—a time when reservists are not distracted by other 

concerns associated with mobilization—would be an effective way to help 

ensure that reservists are aware of the most current information about 

TRICARE. 

DOD also provided technical comments, which we have incorporated 

where appropriate. 

We are sending copies of this report to the Secretary of Defense, 

appropriate congressional committees, and other interested parties. We 

will also make copies available to others upon request. In addition, the 

report is available at no charge on the GAO Web site at 

http://www.gao.gov. 

If you or your staff have questions about this report, please contact me at

(202) 512-7119. Contact points for our Offices of Congressional Relations 

and Public Affairs may be found on the last page of this report. Another 

contact and staff acknowledgments are listed in appendix III. 

Marcia Crosse 

Director, Health Care 

Page 27 GAO-07-195 TRICARE Education for Reservists
Appendix I: Objectives, Scope, and Appendix I: Objectives, Scope, and Methodology 

Methodology 

The National Defense Authorization Act (NDAA) for Fiscal Year 2004 

directed that we study the health insurance coverage of reservists and 

their dependents, DOD’s efforts to provide assistance specifically to 

reservists and their dependents to facilitate their access to and use of 

TRICARE benefits, and reservists’ and their dependents’ experiences using 

TRICARE.1

 To do this, we (1) identified the extent to which reservists have 

civilian health insurance, (2) examined DOD’s efforts to educate reservists 

and their dependents about TRICARE, and (3) described reservists’ level

of satisfaction with TRICARE and the types of problems reservists and 

their dependents experienced when using TRICARE. 

To determine the extent to which reservists had civilian health insurance, 

we obtained data from the Department of Defense’s (DOD) 2003 and 2004

Status of Forces Surveys of Reserve Component Members and DOD’s 2000 

Survey of Reserve Component Members. We discussed the limitations of 

the surveys with DOD officials and determined that the survey data were 

reliable for our purposes. We did not independently assess the reliability 

of DOD’s data. To learn about the extent of TRICARE benefits available to

reservists and their dependents, we reviewed pertinent legislation, 

regulations, documents, reports, and information related to the TRICARE 

health benefits available to activated reservists and their dependents. In 

addition, we interviewed officials in the offices of the Assistant Secretary 

of Defense for Reserve Affairs, the TRICARE Management Activity (TMA), 

the Defense Manpower Data Center, and representatives of the seven 

reserve components.2

 We also interviewed members of selected reserve 

military service organizations: the Enlisted Association of the National 

Guard of the United States; the Reserve Officers Association of the United

States; and the Military Officers Association of America. Finally, we 

reviewed and evaluated reports from the Congressional Research Service

and Congressional Budget Office as well as prior GAO reports. 

To examine DOD’s efforts to educate reservists and their dependents 

about TRICARE, we interviewed representatives from DOD’s TMA, the 

Office of Reserve Affairs, and each of the seven reserve components about 

their efforts to educate reservists about TRICARE. We also interviewed 

officials from outside stakeholder groups. We interviewed over 100 

 1

See Pub. L. No. 108-136, § 705, 117 Stat. 1392, 1528-29 (2003). 

2

The seven reserve components include the Army National Guard and the Air National 

Guard, as well as the Army Reserve, the Naval Reserve, the Marine Corps Reserve, the Air 

Force Reserve, and the Coast Guard Reserve. 

Page 28 GAO-07-195 TRICARE Education for Reservists
Appendix I: Objectives, Scope, and 

Methodology 

reservists from the Army National Guard and the Navy Reserves. We 

selected these two groups because they had large numbers of reservists 

demobilizing that we were able to interview during the course of our work. 

We used these interviews to validate and update information that we had 

gathered from the various surveys that we used as the basis of our work. 

We also reviewed DOD TRICARE Web sites and other materials designed 

to inform servicemembers and their dependents about TRICARE. We 

developed and administered a Web-based survey of benefit counseling and 

assistance coordinators (BCAC) who respond to problems encountered by 

reservists and their dependents when they use TRICARE. With the 

assistance of DOD officials, we identified BCACs who had direct 

experience providing TRICARE counseling and assistance to reservists 

and their dependents. We received survey responses from 226 BCACs who 

were currently engaged in providing TRICARE counseling and assistance.

Because these 226 respondents were not selected at random from a larger 

population of known BCACs, the information they provided cannot be 

projected to any other BCACs. In addition, we reviewed our prior work on

reservists and military health care. We also used DOD’s 2003 and 2004 

Status of Forces Surveys of Reserve Component Members, DOD’s 2002 

Survey of Spouses of Activated National Guard and Reserve Component 

Members, and DOD’s 2000 Survey of Reserve Component Members to 

provide us with information about reservists’ opinions about TRICARE. 

To describe reservists’ level of satisfaction with TRICARE and the types of

problems reservists and their dependents experienced when using 

TRICARE, we interviewed DOD officials as mentioned above, and we 

relied on our own survey of BCACs. We used information from the 

interviews of reservists as described above. We also obtained and analyzed

the results of the DOD’s 2003 and 2004 Status of Forces Surveys of 

Reserve Component Members. 

Finally, the NDAA for Fiscal Year 2004 mandated that we describe DOD’s 

options for continuing civilian health care coverage while reservists are 

mobilized. We did not address this part of the mandate in this report 

because it was addressed in our October 19, 2005 report, Defense Health 

Care: Health Insurance Stipend Program Expected to Cost More Than 

TRICARE But Could Improve Continuity of Care for Dependents of 

Activated Reserve Component Members (GAO-06-128R). 

We performed our work from October 2005 through December 2006 in 

accordance with generally accepted government auditing standards. 

Page 29 GAO-07-195 TRICARE Education for Reservists
Appendix II: Selected Legislation Pertaining Appendix II: Selected Legislation Pertaining to TRICARE Eligibility for Reservists 

to TRICARE Eligibility for Reservists 

Laws Description

National Defense Authorization Act 

for Fiscal Year 2004, Pub. L. No. 

108-136, §§ 702-704, 117 Stat. 

1392, 1525-28 (2003). 

Contained a provision which allowed nonactivated members of the Selected Reserve and the 

Individual Ready Reserve and their family members to enroll in TRICARE if the member was 

eligible for unemployment compensation or was ineligible for health care coverage from his or 

her civilian employer.a

 Another provision allowed reservists who had pending active-duty orders 

to use TRICARE for up to 90 days before their active-duty service began. A third provision

extended the length of time which service members, including demobilized reservists, could use 

TRICARE after they had been released from active duty to 180 days. These provisions were set 

to expire on December 31, 2004. 

Ronald W. Reagan National 

Defense Authorization Act for Fiscal 

Year 2005, Pub. L. No. 108-375, §§ 

701, 703, 706, 118 Stat. 1811, 1980-

84 (2004). 

Indefinitely extended the temporary provision passed in 2003 which allowed reservists with 

pending active-duty orders to use the military health care system up to 90 days before their 

active-duty service began. It also indefinitely extended the temporary provision which extended 

the length of time which service members could use TRICARE after they had been released 

from active-duty service to 180 days. This legislation did not extend the provision which 

authorized TRICARE access for reservists who were eligible for unemployment compensation 

or were ineligible for health care coverage from their civilian employer. 

Another provision provided TRICARE Standard coverage through a new program that DOD 

named TRICARE Reserve Select (TRS). This was made available to reservists who had been 

activated for a period of more than 30 days in support of a contingency operation on or after 

September 11, 2001, and who agreed to continue serving in the Selected Reserves after 

release from active duty. Under this provision, reservists are eligible to purchase TRICARE 

coverage for themselves and their family members for up to 1 year for each 90 days of active 

duty served, or the number of full years for which they agreed to continue service, whichever is 

less.b

 Reservists pay a monthly premium of 28 percent of the total amount determined by the 

Secretary of Defense on an appropriate actuarial basis as being reasonable for coverage. 

National Defense Authorization Act 

for Fiscal Year 2006, Pub. L. No. 

109-163, §§ 701-702, 119 Stat. 

3136, 3339-42 (2006). 

Extended eligibility for TRICARE Standard to all Selected Reserve component personnel. 

Those reservists who meet TRS requirements established in the NDAA for Fiscal Year 2005 will

continue to pay the 28 percent premium. Those who are eligible for unemployment 

compensation, are self-employed, or who are not eligible for insurance through an employersponsored plan will pay 50 percent. Those who do not qualify for the two lower premium levels, 

such as those who are eligible for employer-based insurance but prefer to enroll in TRICARE, 

will pay 85 percent. 

John Warner National Defense 

Authorization Act for Fiscal Year 

2007, Pub. L. No. 109-364, §§ 701-

702, 120 Stat. 2083 (2006). 

Restructures the TRS program by eliminating the three-tiered premium structure. Establishes 

that reservists who are eligible for the Federal Employees Health Benefit Plan are not eligible to 

purchase TRICARE coverage. Under this provision, members of the Selected Reserve will be 

eligible to purchase TRICARE coverage for themselves and their dependents at the 28 percent 

premium rate regardless of whether they have served on active duty in support of a contingency 

operation. In addition, eligibility will not depend on the length of a service agreement entered 

into following a period of active duty; instead, reservists will be eligible for TRS for the duration 

of their service in the Selected Reserve. DOD is required to implement these changes by 

October 1, 2007. 

Source: GAO.

a

Under this temporary provision, eligible reservists would have been required to pay a premium 

equivalent to 28 percent of the total amount determined by the Secretary of Defense on an 

appropriate actuarial basis as being reasonable for coverage. DOD did not implement this provision 

before it expired on December 31, 2004, citing a lack of authorized funds. 

b

Reservists who were ordered to active duty for a period of more than 30 days, but served less than 

90 continuous days due to an injury, illness, or disease incurred or aggravated while deployed are 

eligible for 1 year of TRICARE coverage under this provision. 

Page 30 GAO-07-195 TRICARE Education for Reservists
Appendix III: Comments from the Department Appendix III: Comments from the of Defense 

Department of Defense 

Page 31 GAO-07-195 TRICARE Education for Reservists
Appendix III: Comments from the Department 

of Defense 

Page 32 GAO-07-195 TRICARE Education for Reservists
Appendix IV: 

A

GAO Contact and Staff 

cknowledgments 

Page 33 GAO-07-195 

Appendix IV: GAO Contact and Staff 

Acknowledgments 

Marcia Crosse, (202) 512-7119 or crossem@gao.gov

In addition to the contact named above, Thomas Conahan, Assistant 

Director; Cathleen Hamann; Adrienne Griffin; Carolina Morgan; and 

Suzanne Worth made key contributions to this report. 

TRICARE Education for Reservists

GAO Contact 

Acknowledgments 

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