As current policy stands, children of servicemembers lose access to regular Tricare when they turn 21 years old and achieve ‘adult’ status. This begs the obvious question: What government-sponsored health care coverage is available for ‘adult’, or college-aged, dependents? The answer is the 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 either 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 ‘regular’ Tricare coverage until their 23rd birthday or until their college graduation — whatever 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 servicemembers who have ‘aged out’ (e.g. 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 Required for Tricare Young Adult: Tricare Young Adult must be purchased by eligible adult children of servicemembers and includes monthly premiums as well as cost shares.
- Prime and Select Options: Tricare Prime, an HMO-like option, 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 servicemember sponsor is still providing 50 percent or more of the child’s financial support, then they may be able to extend eligibility for ‘regular’ Tricare up to age 23.
In order 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’s degree or higher). Once the eligibility window is extended, the child dependent either has until their 23rd birthday or until college graduation before Tricare coverage officially ends. 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 servicemembers 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 acts as a health care ‘bridge’ for adult children of servicemembers 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 enables beneficiaries more freedom of choice in finding their own providers, and does not require referrals from a PCM in order to see specialists. However, the out-of-pocket costs can be higher, especially if beneficiaries seek care from out-of-network specialists.
Eligibility & Costs
Am I Eligible?
Eligibility for Tricare Young Adult is based on the beneficiary’s age, marital status, college enrollment status, servicemember’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 step-children) of servicemembers who have effectively ‘aged out’ (e.g. 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.
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. In order to qualify, it’s important to ensure that your information is up-to-date in DEERS prior to 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) and 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.
As of May 2020, premiums for Tricare Young Adult range from $228-$376 per month depending on the above factors. There are no deductibles for Tricare Young Adult Prime, and deductibles range from $52-$313 for Tricare Young Adult Select.
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 in order 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, s/he may 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 your 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.
With the costs of education, housing, and commodities continually on the rise, having 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.