Is TRICARE Young Adult right for your child?

  • Published
  • By TRICARE Communications
FALLS CHURCH, Virginia --  

Is your child turning age 21 or graduating from college soon? Though they lose regular TRICARE coverage upon turning age 21 or age 23 if enrolled full time at an approved college, many young-adult children can continue to get medical and pharmacy benefits up until age 26 through TRICARE Young Adult, or TYA.
 
“It’s essential for young adults to avoid any gaps in their health care coverage,” said Dr. Danita Hunter, chief of TRICARE Policy and Programs. “TRICARE Young Adult is in place to ensure young-adult children can continue having coverage, but it isn’t their only option. Families are encouraged to explore all their health care options, including a parent’s employer-sponsored commercial plan or coverage purchased through a state marketplace before purchasing TYA.”
 
If you’re considering TYA, here’s what you need to know.
 
1. Who TYA is for
Unlike most TRICARE health plans, TYA isn’t offered as a family plan. It’s only available for individuals who qualify. Your child may qualify for TYA if they meet the following criteria:

  • Unmarried adult child of an eligible uniformed service sponsor
  • At least age 21 (Coverage ends when the young adult turns 26 years old.)
  • Ineligible to enroll in an employer-sponsored health plan 
  • Ineligible for any other TRICARE health plan
  • Isn’t a member of the uniformed services

2. What TYA covers
The covered services under TYA are the same as under other TRICARE health plans. TYA coverage includes medical and pharmacy benefits, but doesn’t include dental or vision coverage. TYA offers TRICARE Prime and TRICARE Select coverage. This means when enrolling in TYA, you can choose either TYA Prime (in certain areas) or TYA Select worldwide. If you live in a US Family Health Plan (USFHP) service area and are qualified, you can choose to enroll in USFHP for your TYA Prime option.
 
3. How TYA works
How you get care depends on the plan you choose, TYA Prime or TYA Select. TYA Prime works the same as TRICARE Prime, and TYA Select works the same as TRICARE Select. As described in the TRICARE Young Adult Fact Sheet, if already enrolled, you can switch from TYA Prime to TYA Select or vice versa. Your regional contractor won’t change, but future monthly premiums will.
 
With TYA Prime, you have TRICARE Prime access to health care through your assigned military or civilian primary care manager. TYA Select beneficiaries don’t have a primary care manager. All TYA beneficiaries are eligible for care at military hospitals and clinics, but TYA Select beneficiaries only have access if space is available. USFHP enrollees get care through their primary care provider and can’t access care at military hospitals and clinics.
 
4. What TYA costs
TYA has separate costs based on sponsor status and beneficiary group. You must pay monthly premiums, as well as associated costs for care. Copayments and cost-shares count toward your family’s catastrophic cap. Premiums do not.
 
For TYA Select, cost-shares contribute to individual and family deductibles. Your deductible varies based on your sponsor’s status. TYA Prime has no annual deductible. To see current premiums and costs, refer to the TRICARE Compare Cost Tool and TRICARE Costs and Fees Fact Sheet.
 
5. How to enroll in TYA
To enroll in TYA, your child must first show as TRICARE eligible in the Defense Enrollment Eligibility Reporting System (DEERS). Once eligible in DEERS, you can purchase TYA coverage. After you get confirmation that your application processed, your child must obtain a new Uniformed Services ID card at an ID card office.
 
Unlike TRICARE Prime and TRICARE Select, TRICARE Open Season doesn’t apply when enrolling in TYA. You can also end TYA coverage at any time.
 
If your child qualifies for TYA, review all your health plan options (military or commercial) before deciding if this health plan is the right plan for them. Check out the TRICARE Young Adult Fact Sheet for more information about TYA.
 
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