Increased TRICARE Eligibility for Reservists Presents Educational Challenges
GAO-07-195: Published: Feb 12, 2007. Publicly Released: Feb 12, 2007.
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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.
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.
Recommendation for Executive Action
Status: Closed - Not Implemented
Comments: DOD concurs 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 for more than 30 days. However, because Guard and Reserve members perform duty infrequently, DOD believes training time is at a premium and any training must be prioritized in order to maximize the limited training time available. Moreover, DOD believes it is difficult to hold the interest of an audience to describe a benefit for which they are not eligible. DOD believes that an initial briefing upon entry into the Guard or Reserve and when the member and family will soon be eligible for TRICARE are appropriate. DOD believes that there is an abundance of information about TRICARE that is available to Reservists and their family members. DOD said it will continue to support the ongoing education efforts by the Reserve Components and their parent military department by producing and providing current and timely educational materials. DOD determined the most effective and efficient methods to provide TRICARE education and determined that general awareness is high. Reservists and their family members become aware of TRICARE information by toll-free phone numbers, printed materials, beneficiary advisors, and websites. DOD developed a letter that will be mailed to all Reservists who are being activated in support of a contingency operation when they become eligible in DEERS for TRICARE up to 90 days before the Reservist's active duty begins.
Recommendation: The Assistant Secretary of Defense for Health Affairs should 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.
Agency Affected: Department of Defense: Office of the Assistant Secretary of Defense (Health Affairs)