As the current policy stands, children of service members lose access to regular Tricare when they turn 21 years old. This begs the obvious question: What government-sponsored health care coverage is available for adult or college-aged dependents? The answer is Tricare for College-Aged Dependents and Tricare’s Young Adult option.
Tricare for College-Aged Dependents Top Five
- Regular Tricare coverage ends on 21st birthday. Access to regular Tricare coverage ends when child dependents turn 21 years old, after which health care will need to be purchased, or the eligibility window may be extended.
- Eligibility window can be extended for full-time college students. Students attending college full-time and pursuing a degree may be eligible to extend their Tricare coverage until their 23rd birthday or until their college graduation, whichever comes first.
- Tricare young adult is for unmarried adults who have “aged out.” Tricare Young Adult is aimed to provide coverage for unmarried, adult children of service members who have “aged out” (i.e., are over 21 years of age, or 23 if enrolled in college) of regular Tricare coverage and are not eligible to enroll in their own employee-sponsored health plan. Eligibility ends when the adult child turns 26 years old.
- Premiums are required for Tricare young adult: Tricare Young Adult must be purchased by eligible adult children of service members and includes monthly premiums, as well as cost shares.
- Choose between Prime and Select options. Tricare Prime, and Tricare Select, a managed care option, are both available options depending on the child’s location, sponsor’s status and individual preferences.
Typically, Tricare eligibility for child dependents ends on their 21st birthday. However, if your child is enrolled full-time at an approved educational institute or if the service member sponsor is still providing 50% or more of the child’s financial support, then they may be able to extend eligibility for current Tricare plan up to age 23.
To extend a child’s Tricare eligibility window, the parents must submit a letter to Tricare from the college registrar’s office stating that the child is enrolled full-time, and is pursuing a degree (associate degree or higher). Once the eligibility window is extended, Tricare’s coverage officially ends on the child dependent’s 23rd birthday or at college graduation. At that point, it may be worth looking into purchasing the Tricare Young Adult plan.
What is Tricare Young Adult?
Tricare Young Adult is a premium-based, comprehensive health plan available for purchase for adult children of service members who have aged out of Tricare after their 21st birthday (or 23rd, if enrolled in college). Eligibility for Tricare Young Adult ends when the child dependent turns 26. So, Tricare Young Adult is a health care program for adult children of service members, if Tricare for College-Aged Dependents is not an option. It includes both medical and pharmacy benefits.
Tricare Young Adult – Prime
Tricare Young Adult Prime is nearly identical to the Tricare Prime option in that it is an HMO-like health care plan where beneficiaries receive most of their care through an assigned primary care manager (PCM) at either a military treatment facility or in-network provider. For specialist visits, a referral is required from the PCM. With the Prime option, beneficiaries have less freedom of choice among providers, but the out-of-pocket costs are also among the lowest.
Tricare Young Adult – Select
Tricare Young Adult Select has the same features as Tricare Select. Unlike the Prime option, Select offers beneficiaries more freedom of choice in finding their providers and does not require referrals from a PCM to see specialists. However, the out-of-pocket costs can be higher, especially if beneficiaries seek care from out-of-network specialists.
Eligibility and Costs
Am I Eligible?
Eligibility for Tricare Young Adult is based on the beneficiary’s age, marital status, college enrollment status, service member’s status and eligibility for other employer-sponsored health care plans. This particular plan is aimed to provide coverage for unmarried, adult children (including biological, adopted and stepchildren) of service members who have effectively aged out (i.e., are over 21 years of age or 23 if enrolled in college) of regular Tricare coverage and are not eligible to enroll in their employer-sponsored health plan.
Since regular Tricare coverage ends when beneficiaries turn 21 (or 23 if enrolled in college), eligible beneficiaries can enroll in Tricare Young Adult upon turning 21, so there are no gaps in coverage. To qualify, it is important to ensure that your information is up-to-date in DEERS before enrolling.
Tricare Young Adult is a premium-based health care plan, which means that, in addition to paying cost shares for services, beneficiaries must pay a monthly fee for coverage. The cost of Tricare Young Adult is based on three factors: which option is selected during enrollment (Tricare Prime or Tricare Select), the sponsor’s military status (e.g., active-duty, Reserve, Guard, retired), when the sponsor joined the service and where care is received. A helpful cost matrix for Tricare Young Adult can be found here, which breaks down monthly premiums, catastrophic cap and co-pays for a range of services.
Premiums for Tricare Young Adult range from $259-$459 per month, depending on the above factors. There are no deductibles for Tricare Young Adult Prime. For Tricare Young Adult Select, deductibles range from $52-$313.
For both Tricare Young Adult Prime and Select, the best way to mitigate out-of-pocket expenses is to receive care from in-network providers.
How to Enroll in Tricare Young Adult
Enrollment in Tricare Young Adult is not automatic and requires a call to one of the three regional contractors to complete the enrollment process. It is necessary to complete an enrollment form and receive approval before scheduling any appointments.
Additionally, it is important to update the child’s status and college address in DEERS regardless of participation in the Tricare Young Adult plan (for example, even if your 20-year old — who is still a “regular” Tricare beneficiary — moves away to college). Depending on the child’s college address, they can receive care in a different Tricare region than the sponsor.
Important Tricare Young Adult Resources
Within the United States, Tricare is divided into three distinct regions: east, west and overseas. Health care services are administered via three different contractors, depending on you or your child’s location:
- Tricare East: The eastern portion of the United States is serviced by Humana Military, 1-800-444-5445.
- Tricare West: The western United States is serviced by Health Net, 1-844-866-9378.
- Tricare Overseas: For beneficiaries located outside of the continental United States (e.g. students studying abroad), the lead contractor is International SOS.
With the costs of education, housing and commodities continually on the rise, access to affordable health care is an increasing priority for young adults and their parents. Fortunately, Tricare for College-Aged Dependents and Tricare Young Adult provide options.