By Lizann Lightfoot
TRICARE coverage does not last forever. Military kids can outgrow TRICARE benefits even if their sponsor is still active duty or honorably retired from military service. Thankfully, TRICARE has a plan to ease the transition into adulthood and independent health insurance coverage. If you are over 21, TRICARE Young Adult may be the best insurance plan for you.
In order to sign up for TRICARE Young Adult, you must be all of the following:
- a dependent of a TRICARE-eligible service member, enrolled in DEERS
- not married
- at least 21 years old (but younger than 26)
- not eligible for an employer-sponsored insurance plan at a full-time job
If your military sponsor paid 50% of your college tuition costs, than you must be at least 23 to enroll in TRICARE Young Adult. If you meet these requirements, you can sign up any time at the Beneficiary Web Enrollment website. Young Adult coverage typically begins about one month after your application is submitted and processed. Coverage begins on the first of the month, so applications submitted near the end of one month will not begin until almost two months later. You will also need to acquire an ID card with your sponsor before you can receive medical care.
Coverage options under TRICARE Young Adult
TRICARE Young Adult includes medical and pharmacy services, but does not include any dental care. Emergency room visits, outpatient surgeries, X-rays, and preventative care are all covered under TRICARE Young Adult. For pregnant patients using TRICARE Young Adult, maternity care is included. However, the baby will not be covered after birth unless the baby’s other parent is a uniformed service member or if the baby is adopted by a service member. The service member can enroll the newborn in DEERS to continue TRICARE coverage when the mother is using TRICARE Young Adult.
TRICARE Young Adult Prime coverage is for people who will receive most of their medical care at a military clinic or hospital. They will receive care through their military-assigned Primary Care Manager, which can be a military or civilian provider.
When using TRICARE Young Adult Standard, people typically seek medical care at clinics and hospitals not on a military base. With Young Adult Standard coverage, you are allowed to be seen at a military hospital or clinic only if there is space available–which is infrequent and unreliable. There are additional coverage options for young adults located overseas or in remote locations.
Costs of TRICARE Young Adult
When you first enroll in either TRICARE Young Adult Prime or Standard, you pay the first two months of premium costs up front. After that, monthly premiums will either be charged to your credit card or deducted from your bank by Electronic Funds Transfer. If you fail to make a monthly payment, your coverage can be suspended and you may be locked out of coverage services for 12 months.
TRICARE Young Adult Prime premium costs $319 monthly. Using Prime, if your sponsor is active duty, you won’t pay out-of-pocket for any type of care, unless you are referred to a specialist and pay point of service charges. If your sponsor is retired, you will have co-payments the same as other TRICARE Prime recipients. These range from $11 per day or $25 per visit for different services. You will be charged point-of-service charges if you see a provider without a referral.
TRICARE Young Adult Standard premium costs $216 monthly. Standard coverage includes an annual deductible every fiscal year. (Unless the sponsor is National Guard or Reserve and currently serving an operation more than 30 days long.) You must first pay the deductible amount before TRICARE will assume cost sharing responsibilities. Your deductible amount depends on your military sponsor’s rank and status. If the sponsor is active duty, rank E4 or below, then the deductible is $50 per person (up to $100 per family). For ranks E5 and above, the deductible is $150 per person (up to $300 per family).
Cost shares for Young Adult Standard are the same as other types of TRICARE Standard charges. You are charged based on the service member’s status and location (in the United States or stationed overseas). For example, active duty family members located in the United States are responsible for paying 15% of the negotiated fee for an in-network provider or 20% of the allowable charge for an out-of-network provider. Out-of-network providers can charge up to 15% more than TRICARE’s allowable charge and you are responsible for paying the additional fees.
Ending TRICARE Young Adult coverage
You must end your TRICARE Young Adult coverage if you do one of these things:
- Get married
- Become eligible for an employer-sponsored insurance plan
- Turn 26 years old
- Become eligible for other TRICARE coverage by joining the military
You can un-enroll online or by calling TRICARE in your region. For those seeking more information, the TRICARE Young Adult fact sheet can be downloaded at the TRICARE Young Adult website.
Lizann Lightfoot is an associate editor at Military One Click and a Marine Corps spouse. She can be reached at [email protected]