TRICARE recently extended benefits to young adults under age 26 under certain circumstances as part of the 2010 Patient Protection and Affordable Care Act. TRICARE Young Adult (TYA) opened for enrollment beginning May 1, 2011 and offers coverage for dependents of uniformed servicemembers, dependents must be under age 26, unmarried and not eligible for their own employer-sponsored health care coverage. Previously, TRICARE coverage ended when dependents reached age 21 or age 23 for full-time students (or when the dependents married).
TRICARE Young Adult eligibility:
TRICARE Young Adult
You may be eligible for TYA if you meet the following criteria:
- Must be a dependent of a uniformed servicemember who is participating in TRICARE
- Over age 21* and under age 26
- Unmarried
- No employer sponsored health care coverage of your own
* Those under age 21 are still eligible for standard dependent TRICARE coverage; Participants may be eligible for standard TRICARE coverage until age 23 if they are a full-time student at an approved educational institution.
Coverage available under TRICARE Young Adult:
Regular TRICARE coverage ends at marriage, age 21, or 23 if attending school full-time. TRICARE Young Adult offers eligible dependents the same coverage they previously had under TRICARE until age 26.
Cost: TRICARE Young Adult offers eligible dependents access to TRICARE Standard coverage for monthly premiums of $186. Overall this is an affordable monthly premium compared to many individual health insurance options. Additionally, there are co-pays once you meet your deductible:
| Type of Provider | Outpatient Cost Share | Inpatient Cost Share |
|---|---|---|
| Network Providers (Active Duty Family Member) | 15% of the negotiated fee
|
$16.85 per day ($25 minimum charge)
|
| Network Providers (All Others) | 20% of the negotiated fee | $250 per day or 25% for institutional services (whichever is less) plus 25% for separately billed professional services |
| Non-Network Providers (Active Duty Family Member) | 20% of the allowable charges | $16.85 per day ($25 minimum charge) |
| Non-Network Providers (All Others) | 25% of the allowable charges | $535 per day or 25% for institutional services (whichever is less) plus 25% for separately billed professional services |
| Overseas Providers (Active Duty Family Member) | 20% of the billed charges | Per diem rate ($25 minimum charge) |
| Overseas Providers (All Others) | 25% of the billed charges | 25% for institutional services plus 25% for separately billed professional services |
Note: Rates current as of May 1, 2011 and are subject to change. For more information, please visit the TRICARE Young Adultwebsite.
