The Patient Protection and Affordable Care Act signed by the President last year required civilian health plans to provide medical coverage to children up to age 26. The Act did not give the Department of Defense the authority to offer this benefit through TRICARE. The National Defense Authorization Act for Fiscal Year 2011 (pending signature by the President) extends dependent medical coverage up to age 26.
Specifics of the National Defense Authorization Act for Fiscal Year 11 include:
- Unmarried dependents who age out of TRICARE at age 21 (age 23 if full-time college/university student and dependent on sponsor for more than 50% of financial support) can purchase TRICARE Young Adult coverage under any plan the sponsor qualifies for coverage.
- Premium based program; premiums intended to offset the full cost of coverage.
- Excluded if child is eligible for employer-sponsored plan.
What You Need to Know:
TRICARE Management Activity will implement the TRICARE Young Adult program in two phases:
- Phase 1 – Standard/Extra – 120 days after legislation is signed
- Phase 2 – TRICARE Prime and Uniformed Services Family Health Plan – will follow later in 2011 due to complexity of system and process changes
Once TRICARE Young Adult is implemented:
- Qualified young adults may choose to pay premiums back to January 1, 2011 and file claims retroactively.
- Coverage may be purchased on a month-to-month basis.
- Qualified young adults will be able to change plans when other options become available (i.e., Prime or US Family Health Plan).
- An enrollment card will be issued once coverage is purchased.
- Enrolled young adults may get an ID card after purchase is reflected in DEERS (not before).
- Children of qualified dependents won’t be covered.
- When the young adult turns 26, he/she may purchase continued coverage under TRICARE’s Continued Health Care Benefit. Information at www.tricare.mil/chcbp.
- The premiums will be based on commercial insurance data to cover the costs of providing care.
For more information about the TRICARE Young Adult program, please go to www.tricare.mil/TYA. You can also sign up for e-alerts at www.tricare.mil/subscriptions; look for TRICARE Young Adult under “benefit updates.”
