Most Reservists Have Civilian Health Insurance, and Many Reservists Choose to Maintain Their Civilian Insurance When Mobilized

Most reservists have civilian health insurance, and over half of all  reservists choose to maintain their civilian health insurance during  mobilization. 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. Reservists Covered by Health Insurance at Rates Similar to Those Found in the General Population

The percentage of reservists with health insurance—80 percent—is similar  to that of the U.S. population between 18 and 64 years old. According to the survey and our interviews with DOD  officials, many reservists maintained their civilian health insurance to  avoid disruptions associated with changing to TRICARE and to ensure that  their dependents could continue seeing their current providers who may  not accept TRICARE. These briefings are  supplemented by family support programs, Web sites, toll-free customer  assistance numbers, and print materials. DOD Is Educating an Increased Number of Reservists and Dependents about TRICARE

Increased mobilizations of reservists and continuing changes to TRICARE  eligibility have increased the number of reservists and dependents that  DOD must educate about TRICARE. DOD Uses a Variety of Tools to Educate Reservists and Their Dependents about TRICARE

DOD relies on a several methods to educate reservists and their  dependents 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. In addition, briefings at mobilization and  demobilization sites typically do not include reservists’ dependents. 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’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. Appendix I: Objectives, Scope, and 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. 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.
Why GAO Did This Study

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 Found

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.