One of the trickiest parts of having young adult children is making sure that they have access to health insurance. While the Affordable Care Act (ACA) mandated that insurance companies extend children’s coverage to age 26, that mandate doesn’t apply to Tricare because technically Tricare isn’t insurance. And federal law prohibits kids from remaining on their parent’s Tricare once they turn 21, or 23 if they are in school full-time. As a work-around, the 2011 National Defense Authorization Act (NDAA) permitted the Department of Defense to create a premium-based version of Tricare to be available to kids between the time they age out of Tricare (21/23) and age 26. The product that was created is called Tricare Young Adult (TYA).
Who Can Get TYA?
Eligibility for TYA is pretty simple. The beneficiary must be:
- Adult child of a Tricare-eligible sponsor
- At least 21 (23 if full-time student) but not yet 26
- Not eligible for healthcare through their own employer’s sponsored program
How Does TYA Work?
TYA works almost exactly like regular Tricare. Beneficiaries choose between Tricare Prime and Tricare Standard. Each program works just like it does if you’re not on TYA, with a couple of little adjustments.
How Much Does TYA Cost?
For 2023, TYA Select premiums will be $291 a month. TYA Prime premiums will be $570 per month. In addition, the child will have a deductible and co-payments that correspond to their sponsor’s status (AD/retired) and which Tricare they have chosen, but those co-pays are Group B co-pays regardless of when their sponsor entered the military. TYA premiums are re-calculated every couple of years to ensure they are covering the costs of this self-funding program.
The other significant cost to consider is the catastrophic cap. The catastrophic cap is the most that you’ll pay out of pocket for covered services.
But of course, it has to be more complicated than it seems.
The family member using TYA is subject to the Group B catastrophic cap for the sponsor’s status (AD or retiree), even if the sponsor is Group A. BUT the rest of the family still uses the Group A catastrophic cap, even while there is a kid using TYA.
For example, our family uses Tricare Select as retirees, and we have one kid on Tricare Young Adult Select. Our family catastrophic cap is $3,706 this year, and for everyone except the TYA kiddo, we stop paying once we reach that limit. But she will then have to accrue an additional $215 of costs before she stops paying.
Let me show you how that looks on our Explanation of Benefits.
First is an EOB for me, that shows our family information:
Compare that with the EOB for our TYA kid:
You’ll also see that because she is Group B, she has two different deductibles.
The catastrophic cap will revert to the regular level once no one is using TYA. This is all funky and makes no sense, but it is true.
Note about Group A and Group B: Group A and Group B refer the date the sponsor entered the military. If the sponsor entered the military before 1 January 2018, you are Group A – except for certain exceptions such as those on TYA, who always get treated as Group B. If the sponsor entered the military on or after 1 January 2018, you are Group B.
Amounts that apply to your catastrophic cap apply for the entire year, even when you switch status or groups or move plans.
How To Enroll in TYA
You can enroll in TYA over the phone, by fax, by mail, or via the MilConnect website.
You’ll want to do this about a month before the child loses their regular Tricare eligibility, to ensure that there is no lapse in coverage. You’ll have to pay for the first two months’ premiums when you enroll.
What Are The Other Options?
TYA isn’t the only option for children who have aged out of regular Tricare coverage. Other choices include:
- Obtaining employment that offers healthcare coverage
- Insurance through their college or university
- A different parent health insurance policy
- ACA coverage purchased through the healthcare exchange
- Healthcare sharing plans
- Private health insurance
- Medicaid, if eligible
When comparing options, be sure to consider not only the monthly premium but also the deductible, costs for care, and catastrophic caps. Most families can find cheaper coverage, but it almost never covers as much as Tricare. You have to think about how much care your child typically uses, and what kind of risk you’re willing to assume for a major illness or accident.
People who say, “TYA is too expensive” probably don’t have all the information.
Getting a Military ID for TYA Beneficiaries
Young adults using TYA are eligible for a military ID that shows their eligibility for medical care. Your child will need to get a new military ID just for TYA, because the old one will expire. You can’t get the new ID until the child is eligible for TYA, even if you set up the TYA earlier.
And if DEERS shows that they don’t graduate from college until later, you’ll need to update that first before getting the new ID. And sometimes, DEERS and the Tricare contractor just don’t talk to each other well. They can get an ID at the local pass and ID office just like everyone else.
Tips and Tricks for TYA
While TYA is pretty straight-forward, there are a few things that it helps to know:
Technically, TYA is not supposed to talk to the parents because these kids are legally adults. Your results may vary – some parents are able to sign their kids up over the phone and in other situations, the child needed to do it themselves.
If your child obtains a job with health insurance, have them properly dis-enroll from TYA. This preserves their TYA eligibility in case they don’t remain in that job and need to go back on TYA.
Keep all your paperwork, and open all your mail. Anecdotal evidence suggests that there are more problems with TYA enrollment than non-YA enrollment. You never know when you’ll need to prove that your kid was actually enrolled, or was dis-enrolled incorrectly. It’ll be a lot easier if you know what’s going on, and have the paperwork to prove it.
TYA is a valuable benefit for kids who are aging out of Tricare but aren’t yet covered by employer health care. As with just about everything else in life, understanding the program is key to making a good choice.
Please share your experiences, nuggets of wisdom, or questions in the comments!