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 2022, TYA Select premiums will be $265 a month. TYA Prime premiums will be $512 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!
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Don Berry says
Kate — good piece, good summary especially the pro/cons of TYA.
One takeaway ought to be though … if you are over 18 … in all but two states you are an adult.
Throughout your piece you paint a picture of parents needing to make the insurance decision for their adult child. Best thing for those ‘kids’ as you call them is for them to make their own decision. TYA is one of the options and as you illustrate a very good one … but it needs to be their choice.
I agree with you that the $3,500 cap increase does not make sense. TYA has a separate premium and ought to be treated as a separate policy with eligibility expiring at age 26.
Treating 21 or 23 yo as kids and making their decisions for them … as you wrote here is a mistake —
“You can enroll in TYA over the phone, by fax, by mail, or via MilConnect.com.
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.”
That’s how you end up with 26year olds living in your basement.
The facts of your post are good summary and coverage of TYA.
Janna Witherel says
Can you address the differences or pros/cons of TYA Prime vs. TYA Standard? I’m having a hard time distinguishing which we should sign up for. Thank you
Hi Kate, Thank you for all the time you put into answering questions.
My 24-year-old child is disabled and has Medicaid. I have Tricare for Life. He has been designated as a disabled adult child for SBP. Is is advantageous to apply for Tricare coverage as well? Many providers don’t like TC because of the low payout and the delays in payment. And then there’s the cost of the premiums.
Thank you for your thoughts.
Kate Horrell says
Hi Mark. I’m getting all the interesting questions today! As I understand it, the process for designating a child as a secondary dependent for SBP is the same process as Tricare entitlement – it’s all the same. If I am correct about that, your son is already eligible for Tricare, though if you’re a retiree and haven’t enrolled him in either Standard or Prime, then he’s only eligible for direct care (at a MTF.) The trick is that Medicaid pays second to Tricare, so you *may* be right to be concerned about this. It’s a little outside my area of expertise, but there is a great Facebook group https://www.facebook.com/militaryspecialneedsnetwork/ that might have some answers for you.
I’d be glad to talk this out with you more.
We are trying to decide whether or not to keep Ty’s. Our daughter is 24 and freelances in another state and so it’s been challenging. Would she be better off getting her own policy? The $358 monthly seems very high. Since her income is $45k, she might get subsidies if I understand correctly. We welcome any advice.
Kate Horrell says
Every person’s situation is different. I consider TYA to be very competitively prices for the outstanding coverage that it provides…particularly since your daughter would remain under your family catastrophic cap. If you are comparing it to other policies, be sure to consider not just the monthly premium but also the deductible, on-going costs, and catastrophic caps.
You may also consider Tricare Select vs. Tricare Prime. Depending on your status and the availability of military treatment facilities, Select can have lower on-going costs and still has the same catastrophic cap. Many families find that Select saves them money because they are only paying their catastrophic cap amount and not the higher premiums of Prime.
My daughter is 24 years old and in the army. I am active duty. Before the army she always was on my Tri care insurance. Now she has her own Tri care insurance. She wants to leave the army next year. Is she eligible for Tri care young adult? Also
as the sponsor am I legally responsible for paying her premium every month until she’s 26. I don’t wanna go against the law and I think it is 26 years old that we have to offer her the inssurance I’m just trying to find out whether we have to pay for her premiums or is she responsible for paying the premiums. I don’t want to do anything not legal.
Kate Horrell says
As long as your daughter otherwise meets the qualifications, she is eligible for TYA. Who pays the premiums is up to your daughter and you.
My almost 24 year old daughter just competed graduate school and is starting her first job this week. She has been on Tricare Young Adult select for 11 months. Her new employer offers health insurance but it is $600/month- she will barely have enough money to pay for housing and food with this health insurance premium. Must she give up TYA? If yes, then how long will she have to dis-enroll from TYA? Her new insurance will begin Oct 1 if she goes with it. Thank you.
Kate Horrell says
Former dependent children are only eligible for TYA if they do not have access to employer-sponsored healthcare. It’s important that she properly disenrolls in TYA in order to maintain her eligibility in case she needs to go back on TYA while she is still eligible.
It’s unfortunate that civilian health insurance is so expensive, but it is.
My daughter is 23 and has graduated from college and has been hired for a position as a “contract worker” in which they do not offer benefits. Is she eligible for TYA if not enrolled in college? They are wanting proof that she is in college to continue her TYA.
Kate Horrell says
TYA is specifically not tied to college enrollment. I’m thinking there is some miscommunication if “they” are wanting proof that she is college. Here is the webpage with instructions for TYA enrollment: https://www.tricare.mil/Plans/Enroll/TYA
My daughter is 22 and will be graduating from college in May. She already has been offered employment but will not begin until July. She has a chronic disease which requires VERY expensive infusions every 8 weeks, so it is important that she has insurance between May and July. My question is will her deductible and catastrophic cap begin anew when she switches from Select to TYA, or does it carry over from what we have already spent this year? Thank you!
Kate Horrell says
Angela, thanks so much for asking. Your question reminded me that I wanted to do some updating to the catastrophic cap section of this article 🙂
Her catastrophic cap does not begin anew, but it does go up. The deductible gets a little more complicated, too.
See if I explained it will enough in the revisions to the article, and let me know if you have any other questions.
lGood day Ma’am,
thank you for all this information we appreciate it. My question is, is my son still eligible to get dependent ID card? He turned 23 last January and he is under her Mom’s health insurance.? I went to DEERS/ID here in Korea and they said that I need to enroll him first to tri-care TYA, is that true? Is it possible to get him the ID even if the health insurance is not tri-care?
Kate Horrell says
Assuming your son is not disabled, he does not qualify for a military ID card at the age of 23 unless it is for Tricare Young Adult. If he does enroll in Tricare Young Adult, the ID card issues is *only* for Tricare Young Adult and does not include any other privileges such as commissary, etc.