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.
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
Tricare Young Adult Prime
Tricare Young Adult Prime coverage is for dependents who will receive most of their medical care at a military clinic or hospital. They will receive care through their assigned primary care manager.
Are you are familiar with how an HMO health insurance plan works? Tricare Young Adult Prime is very similar to an HMO. With Tricare Young Adult Prime, you are assigned a primary care manager, also known as your PCM. Your PCM will provide most of your health care needs.
The primary care manager will make referrals to see specialists if your condition requires specialized attention the PCM cannot provide. The PCM works with your regional contractor for specialized care authorization — Humana Military for the East and Health Net for the West.
Generally, your primary care manager will be either a military or network provider. Sometimes, they are civilian doctors. If you are receiving care under Tricare Young Adult Prime, you do not need to worry about filing any claims because your PCM will file your claims for you.
Just like the Tricare Prime program, you will have annual deductible and copayments. These are due at the time of service.
The monthly premium for Tricare young Adult Prime is $324. You must pay the first two month's premium costs up-front at the time you enroll. Although you have the option of paying your up-front premiums by check, money order or credit/debit card, you will be required to set up reoccurring bank transfer or recurring credit/debit card payments for your future monthly premiums.
Overview of Tricare Young Adult Standard
Tricare Young Adult Standard
The Tricare Young Adult Standard program option allows you to see any doctor you choose as long as he to she is an authorized provider.
It should be no surprise that if you see a doctor within the Tricare network you will pay less out-of-pocket expenses for that care, but that option is available to you.
However, another benefit of seeing a health care provider within the network is that they will file your claim for you – less paperwork for you.
Tricare Young Adult Standard is a premium-based, health insurance plan. Beneficiaries are required to pay a monthly premium. It offers coverage similar to Tricare Standard and Tricare Extra for military members and their eligible family members. You do not need a referral for any type of care, but some services may require prior authorization to be covered.
Just like the Tricare Prime program, you will have an annual deductible and copayments. Copayments are due at the time of service.
The current premium for the Tricare Young Adult Standard program is $225 per month. As with Tricare Young Adult Prime, you must pay the first two month's premium costs up-front at the time you enroll. Although you have the option of paying your up-front premiums by check, money order, or credit/debit card, you will be required to set up automatic bank transfers or recurring credit/debit card payments for your future monthly premiums.
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
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:
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