Tricare Young Adult is a health coverage plan specific to young adults who are unmarried and still qualify as dependents, but have “aged out” of the Tricare program.

This specific plan is tailored for children of active and retired military who are attending college.

Tricare Young Adult, also known as TYA, provides comprehensive medical and pharmaceutical benefits for adult children between the ages of 21 and 26 who qualify.

Tricare is one of many healthcare programs offered by the United States Department of Defense Military Health System. Tricare provides civilian health benefits for active and retired military personnel and their qualified dependents.  Some members of the Reserve Component are qualified to receive Tricare benefits as well.

Historically, Tricare was known as CHAMPUS: the Civilian Health and Medial Program of the Uniformed Services. Congress passed the Military Benefits Amendments of 1966 which worked along side the Dependents Medical Care Act of 1956. This legislation allowed the Secretary of Defense to contract with civilian health care providers to meet the increased demand the years following World War II and the Korean War.

In 1993, as a result of the requirements laid out in the Department of Defense (DoD) Appropriation Act for Fiscal Year 1994, the DoD announced plans for a nationwide managed care program for military personnel and their dependents, active and retired. This program became known as Tricare.

Who is Eligible for Tricare Young Adult (TYA)?

Any dependent reliant on an eligible militant sponsor can sign up for Tricare Young Adult. The dependent must be unmarried.

The defendant must be at least 21 years old, but not exceeding 26 years.

Eligibility starts after the age of 23 for those dependents who are full time students, and are admitted to an approved institution.

Also, they are eligible for benefits under Tricare Young Adult if 50 percent of their financial expenses are provided by their sponsor.

What to Expect When Signing Up for Tricare Young Adult

TYA offers open enrollment. If you meet the eligibility qualifications, you may purchase Tricare Young Adult coverage at any time.

The TYA Application is available on the Tricare Website. When applying, you must verify that you are not married and not eligible to enroll in an employer sponsored health plan.

Your parent or sponsor must add you to the Defense Enrollment Eligibility Reporting System (DEERS) before you apply.

Young Adult Signing

After enrolling in TYA, you and your sponsor will need to visit a uniformed services identification card-issuing facility to obtain an ID card for you.

If you enroll in TYA Standard, your coverage will begin the first day of the next month after your enrollment application is processed and payment is received.

If you enroll in TYA Prime, your coverage will follow the 20th-of-the-month rule: As long as your enrollment application is received by the 20th of the month, coverage can begin on the first day of the next month. If it is received after the 20th of the month, it will start the first day of the month after next.

Tricare Young Adult Plan Options: Standard and Prime

If you are a young adult who is no longer eligible to be on your parent’s Tricare plan, there are two plan options that you can consider under Tricare Young Adult: Tricare Young Adult Prime and Tricare Young Adult Standard.  These plans work the same as Tricare Standard and Tricare Prime.

Generally speaking, Tricare Prime works like any HMO plan where you see a doctor in a network and he or she makes referrals for specialized care.

Tricare Standard works much like a PPO where you can see any doctor you choose, and you do not need referrals to see a specialist.

The difference is the costs associated with each plan.

Overview of Tricare Young Adult Prime

Overview of Tricare Young Adult Standard

Tricare Young Adult and The Affordable Healthcare Act

The Affordable Care Act (ACA) requires everyone to maintain basic health care coverage. This is called minimum essential coverage under the Affordable Healthcare Act. You will have to pay a fee for each month you do not maintain minimal essential coverage.

Tricare Young Adult is considered minimal essential coverage under the Affordable Healthcare Act. If you are receiving benefits from TYA, you do not need to purchase any additional additional coverage to meet the minimum standards as directed by the Affordable Healthcare Act.

What is Medical Services Are Covered Under Tricare Young Adult?

Medical services and pharmaceuticals are covered under Tricare Young Adult. You can count on emergency room visits and outpatient surgeries to be covered. Also, Tricare Young Adult covers your x-rays, and any preventative care.

If you receive benefits from Tricare Young Adult and are starting a family, consider this: although pre-natal care is included, unless the baby’s other parent is a uniformed service member, the child will not be covered after birth.

The service member does have the option to enroll their child in DEERS if they wish to continue Tricare coverage.

Tricare Young Adult Life Coverage Limitations

Young Adult Limitations

Like any healthcare insurance plan, Tricare coverage has its limitations.  For example, Tricare does not cover chiropractic care because it cannot be administered in a doctor’s office or a hospital. Tricare does not cover abortions, emergency contraceptives, or any cosmetic surgery.  It does not cover non-surgical treatment for weight loss, or over-the-counter products that help you quit smoking.

Probably the biggest down side is that Tricare does not cover dental work.

The Factors Make You Ineligible for TYA

As we have discussed, Tricare Young Adult is a healthcare program for for unmarried, adult children who have “aged out” of regular Tricare coverage. However, you are no longer eligible for this plan for any of the following reasons:

  • You get married.
  • You are eligible for an employer sponsored insurance plan.
  • You turn 26 years old.
  • You join the military and become eligible for other Tricare medical coverage.

Questions about Tricare Young Adult? Get in Touch Here

If you have any questions about Tricare Young Adult, or other health care benefits available under Tricare, contact one of the regional offices or regional contractors. In most cases you will contact your regional contractor.

However, if you are looking for Prime Travel Benefits approval, eligibility requests for Tricare Prime Remote, or need to resolve an issue with your regional contractor, you should contact your Tricare Regional Office.

  • Tricare East Regional Contractor (Humana Military): 1-800-444-5445
  • Tricare West Regional Contractor (Health Net): 1-844-866-9378
  • Tricare East Regional Office: 1-844-204-9351
  • Tricare West Regional Office: 1-800-558-1746

Pin It on Pinterest

Share This