Reprinted with permission from GPSolo magazine, March/April 2019 (36:2), at 20-23. ©2019 by the American Bar Association. All rights reserved. This information or any or portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association.
The U.S. Armed Forces is a self-contained community populated by approximately 5 million military servicemembers and their families and 23 million veterans serving in the seven uniformed services (Army, Navy, Air Force, Marine Corps, Coast Guard, Public Health Service Commissioned Corps, and National Oceanic and Atmospheric Administration Commissioned Officer Corps). Like all good communities, the U.S. Armed Forces provides services and benefits to its members to retain them in service and to partially compensate for the sacrifices members and their families make when they become part of the community. Along with health insurance and health care, the best-known of these benefits, come other, less well-known perquisites of membership, including travel, entertainment, and death benefits.
The recent and heated debates about government-provided health insurance coverage usually ignore that the federal government currently provides health insurance for almost 10 million people through the Department of Defense (DoD) and another 9 million people through the Veterans Health Administration (VHA). Those people are the members of the U.S. Armed Forces, whether active, reserve, or retired, and their families. They are all covered under various programs administered by the DoD Health Benefits Division or the U.S. Department of Veterans Affairs (commonly known as the VA).
Military servicemembers on active duty have always enjoyed free medical care, not just insurance, provided by medical providers at military-run hospitals and facilities around the world. The DoD has a vested interest in making sure that the members of its armed forces are healthy and able to do their job defending the country, so they ensure that every servicemember has access to necessary medical care. To retain the best people in military service, the DoD promises that retirees will have medical coverage for life. The DoD also recognizes that servicemembers will not perform optimally if they’re worried about their family’s access to medical care, so part of what the DoD provides to its servicemembers is access to medical care and health insurance for their families at a reasonable cost.
The result of all these promises by the DoD is a system of health insurance, medical care, and medical benefits that in some ways mimics civilian health insurance and in others provides a mind-numbing array of benefits for military servicemembers that is unheard of in the civilian world. The two major types of providers of medical and health insurance coverage for the military are TRICARE and the VA.
TRICARE. TRICARE is the primary provider of health insurance and medical benefits for military servicemembers. Think of TRICARE like the largest health insurance provider in the country. The people who are eligible for TRICARE coverage are active-duty servicemembers and their families, retired servicemembers and their families (unless they are eligible for TRICARE for Life), active-duty and retired National Guard and reservists and their families, survivors of servicemembers, and Medal of Honor recipients and their families. Former spouses of servicemembers are eligible for TRICARE if they were married for 20 years to a servicemember who served for 20 years with a 20-year overlap of marriage and service; these are called 20/20/20 spouses. If there is only a 15-year overlap of marriage and service, the former spouse is entitled to only one year of medical insurance coverage; these are called 20/20/15 spouses. TRICARE has a number of different programs available to its eligible members.
Active-duty servicemembers must enroll in TRICARE Prime. All other eligible members may enroll in TRICARE Prime, unless they are eligible for or choose other coverage through TRICARE. Reservists and National Guard members and their families are only eligible for TRICARE Prime while they are actually on active duty, but they have access to similar coverage under TRICARE Reserve Prime. TRICARE Prime is the DoD equivalent of an HMO in the civilian world, except that it is free to all active-duty servicemembers and their families. Retirees and their families pay an annual enrollment fee that is considerably less than most civilians’ monthly health insurance premium; retirees are also required to pay a small co-pay for services. Under TRICARE Prime, each member is assigned a primary care manager, who is the equivalent of a primary care physician. That person manages care and makes referrals to any necessary specialists. All primary care managers are doctors who are also servicemembers. Most specialists are also servicemembers, unless the military does not have a specialist in a particular field of medicine or lacks adequate choice of such a specialist, in which case servicemembers are permitted to use doctors from the list of providers available under TRICARE Select.
A subset of TRICARE Prime is the US Family Health Plan. This is TRICARE coverage, available regardless of whether family members qualify for TRICARE for Life. This program is limited to people who live near one of six not-for-profit medical centers in the United States. The participants must receive their non-emergency care from their local center, but are covered for emergency care anywhere. There is no enrollment fee or co-pay for active-duty members. Everyone else pays an annual enrollment fee, which again is a fraction of the monthly premium paid by most civilians, plus some small co-pays.
TRICARE Select, and its separate but comparable coverage for reservists and members of the National Guard, is available to everyone eligible for TRICARE coverage except active-duty servicemembers. TRICARE Select is a typical point-of-service health insurance plan in which patients pay in-network medical service providers a small co-pay and must file a claim for reimbursement for out-of-network providers and generally end up paying more for out-of-network care. Participants also must meet a deductible amount before TRICARE will pay for any expense, but the deductible at the time of the writing of this article is $100 or less. Active-duty family members pay no enrollment fee; all others pay an annual fee that, again, is far less than most civilians’ monthly health insurance premiums cost. The reason someone would select this coverage is to broaden the pool of available health care providers beyond military doctors and hospitals and allow access to civilian doctors, even overseas. This coverage is particularly important in areas and specialties that are not well represented by military doctors, and for individuals with small military medical centers and providers nearby.
Children of servicemembers age out of the regular system at age 21, unless they are full-time students and their TRICARE-eligible sponsor provides more than half their financial support, in which case they age out at the first to occur of their reaching age 23 or graduation. As in the private health insurance world, TRICARE provides coverage for unmarried adult children between the ages of 21 and 26 who are the dependents of a TRICARE-eligible sponsor, not eligible for health insurance coverage through an employer-sponsored plan, and not otherwise eligible for TRICARE coverage. There are two levels of coverage: Prime and Select. Prime coverage meets the minimum coverage requirements under the Affordable Care Act. Unlike TRICARE plans, it requires a monthly, not annual, premium payment, which is comparable to that paid in the civilian sector. Select coverage is the same as regular TRICARE Select.
Retirees who are 65 years old or older are no longer eligible for any of the TRICARE programs already discussed except the US Family Health Plan. These retirees must elect either regular Medicare coverage or TRICARE for Life coverage, which is a Medicare supplement that still permits the retiree to utilize military medical facilities and providers. The cost for these programs is the same as for Medicare Part B coverage.
If an eligible individual needs dental care, TRICARE covers that as well, with three available plans. Active-duty servicemembers are covered under the TRICARE Active Duty Dental Program, which provides free civilian dental care for servicemembers, reservists, and National Guard members who are on active duty. TRICARE Dental Care provides dental insurance coverage for family members of active-duty servicemembers, reservists, and National Guard members. TRICARE Retiree Dental Program provides dental coverage for retirees, Medal of Honor recipients, their families, and survivors.
Civilian insurance providers routinely include provisions for continuation of insurance coverage when there’s a change of status, such as divorce or separation from service. Fear not, the military has that covered as well. The Continued Health Care Benefit Program (CHCBP) is the military’s version of COBRA coverage and provides continuation coverage to honorably or generally discharged servicemembers, their families, former spouses, and dependent children who lose their coverage because of change of status. Coverage under CHCBP is the same as for TRICARE Select and lasts for 18 to 36 months.
Veterans Health Administration benefits. Those veterans who served at least 24 months or their full tour of active duty since September 1980 and who were not dishonorably discharged, or those veterans who were discharged for a service-related disability or a hardship or “early out” are entitled to apply for Veterans Health Administration (VHA) benefits. The VHA is part of the VA and not in any way affiliated with TRICARE or the DoD. Eligibility for VHA benefits is determined by a series of eight priority groups. Income may also be a determining factor, and those with private health insurance or with income above minimum levels are required to pay a co-pay for services. Like TRICARE Prime, the VHA is a managed care system in which beneficiaries have a primary care manager, who then refers the veteran to specialists and services and VHA medical centers and hospitals. Except for those individuals whose income requires a co-pay, all services provided by the VHA are free to eligible veterans.
The services provided by the VHA are extensive and somewhat mind-boggling. All eligible veterans receive preventative care, medical and hospitalization, mental health service, immunizations, and prescriptions for medicine prescribed by VHA doctors. Some veterans are also eligible for eyeglasses, hearing aids, dental care, and medical equipment. The VHA also provides home health care, palliative and hospice care, maternity care, and some nursing home care. The VHA is a comprehensive medical system with medical centers and hospitals across the country.
There are other, less well-known benefits to being a servicemember (active-duty or retired) or a member of a servicemember’s family. The Information, Tickets and Travel office, which is a division of the Morale, Welfare and Recreation program (MWR), offers discount tickets to special events and attractions, lodging, and cruises. Paths Across America, another division of MWR, operates campgrounds and RV sites across the United States. If a servicemember and his or her family needs lodging on vacation, there are resorts in Korea, Germany, Japan, and across the United States, all owned and operated by the DoD. Certain, qualified servicemembers and retirees and their families may also find lodging on some military bases at a greatly reduced cost. This benefit is also extended to those honorably discharged veterans who have a service-connected disability rated at 100 percent.
Many people have heard of Space-A Travel by its other name, Military Hops. This service provides servicemembers, retirees, and their families, as well as qualified National Guard members and reservists, travel around the world on space-available flights through military terminals. There is a ranking of priority for space on these flights, as they are also methods of transport for active-duty servicemembers flying under military orders.
Military bases provide housing for active-duty servicemembers, either barracks for servicemembers without dependents or houses for servicemembers with families. For those active-duty servicemembers who choose to live off-base, the military provides a monthly basic allowance for housing (BAH) to defray housing costs. BAH is based on the rank of the servicemembers, whether they have dependents, and where they are stationed. This benefit is not taxed. Servicemembers, but not their dependents, also receive a basic allowance for subsistence (BAS) to help defray the costs of meals.
The VA provides home loans, including cash-out refinances, at affordable rates without the requirement for a down payment or private mortgage insurance. Eligibility for this service depends on the length and character of service and duty status.
Every branch of the service has a post exchange (PX) or base exchange (BX), which are retail stores that are similar to department stores, and commissaries, which are like grocery stores, at most bases. The stock and variety of goods at the PX, BX, and commissary depends on the location. All these stores sell their goods tax free. The commissaries sell goods at cost plus 5 percent. Uniformed servicemembers (active, retired, or reserve), Medal of Honor recipients, honorably discharged veterans with 100 percent disability ratings, DoD civilian employees outside the United States, survivors of servicemembers, and 20/20/20 spouses are all eligible to use these services.
The military also offers scholarship programs for children of servicemembers, as well as the Military Education benefit, also known as the GI Bill. The Post-9/11 GI Bill provides different levels of education benefits to servicemembers (and their dependents) who have been on active duty for 90 or more days after September 10, 2001, based on active-duty time. The military offers similar benefits for reservists and members of the National Guard.
The military also offers burial and memorial benefits to active-duty, reserve, and veterans discharged under conditions other than dishonorable, their spouses, minor children (under the age of 21 or 23 if a full-time student), and some parents of servicemembers. This benefit includes internment at a VA national cemetery, headstones or markers, partial reimbursement of burial and funeral costs, and military funeral honors, including a burial American flag.
Today’s military is quite unlike your parents’ military. In recognition that a compulsory system of military service no longer exists, and that the sense of duty drives fewer people and their families to endure the hardships that come with military service, the U.S. Armed Forces has greatly increased the benefits offered to servicemembers to retain the best and the brightest in military service. Although military pay is intended to track private-sector wages, the mechanism for determining the military pay scales is cumbersome. Additionally, nowhere in the private sector must employees and their families regularly endure the hardships of military life, with its frequent relocations of family, temporary absences from home of varying lengths, along with the danger and hardship of being deployed or stationed in a combat or hazardous duty zone. Pay alone cannot compensate for these variables, and by providing additional benefits outside of pay, the U.S. Armed Forces attempts to compensate its members for their sacrifices.
Published in GPSolo eReport, Volume 9, Number 3, October 2019. © 2019 by the American Bar Association. Reproduced with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association.