Defense Health Agency: Get to Know Your TRICARE Young Adult Plan

FALLS CHURCH, Virginia, Sept. 12 -- Defense Health Agency issued the following news release:

Did you know that if you're a TRICARE beneficiary turning age 21, you may no longer be eligible for regular TRICARE coverage? But don't worry--even if you've aged out, you may still be eligible for TRICARE Young Adult (TYA). TYA is a premium-based health care plan. There are two options for TYA--TRICARE Young Adult Prime and TRICARE Young Adult Select. Your sponsor's status and your geographic location determine whether you can purchase either TYA Prime or TYA Select. As highlighted in the TRICARE Young Adult Program Fact Sheet, TYA Prime is available in designated geographical areas and TYA Select is available worldwide.

"When kids age out of TRICARE Prime or TRICARE Select, TYA is a great option for health care coverage if, for example, they don't have coverage from an employer," said Mark Ellis, chief of the Policy and Programs Section of the TRICARE Health Plan at the Defense Health Agency. "TYA helps kids transition into adulthood and into having independent health insurance."

Who can enroll in TYA?

Young adults must show as eligible in the Defense Enrollment Eligibility Reporting System (DEERS) to enroll in TYA. Keeping DEERS up to date is essential to get your TRICARE benefits.

You can purchase TYA coverage if you're:

* An unmarried, adult child of an eligible uniformed service sponsor

* At least age 21, but not yet age 26 (see further restrictions)

* Ineligible for an employer-sponsored health plan under your own employment as defined in TYA regulations

* Not otherwise eligible for other TRICARE program coverage

* Not a uniformed service sponsor (for example, an active duty service member or a member of the Selected Reserve)

Anyone who qualifies for TYA may enroll in TYA Select. However, those who are only eligible for TYA Prime include:

* Children of active duty sponsors in all U.S. locations and in all overseas areas, if command-sponsored

* Children of retired sponsors if they live in a Prime Service Area

If you're TYA Prime eligible and live in an area where the US Family Health Plan (USFHP) is offered, you may choose USFHP for your TYA Prime option.

How do you get care with TYA?

How you get care depends on if you choose TYA Prime or TYA Select. TYA coverage includes medical and pharmacy benefits, but not dental coverage.

If you have TYA Prime, you have access to care through an assigned military or civilian primary care manager. USFHP enrollees get care through their primary care provider. TYA Select works just like TRICARE Select, so you can visit any TRICARE-authorized provider.

All TYA beneficiaries are eligible for care at military hospitals and clinics, but TYA Select beneficiaries have access only when space is available. And TYA Prime beneficiaries enrolled in the USFHP can't access care at military hospitals and clinics.

Learn more about TRICARE-covered services and provider types.

What are the costs with TYA?

To participate, you must pay monthly premiums. TYA premiums get adjusted each year. They don't count toward your deductible or catastrophic cap. Costs depend on sponsor status, beneficiary group, and TRICARE plan.

With TYA Prime, you'll pay monthly premiums and TRICARE Prime copayments, if required. Any care received without a referral from a primary care manager is subject to point-of-service fees.

With TYA Select, you'll pay monthly premiums, deductibles, copayments, and cost-shares. Costs vary depending on the sponsor's military status.

For specific costs, both TYA Prime and TYA Select follow Group B cost-shares, deductibles, and catastrophic caps. Use the TRICARE Compare Costs Tool to view TYA costs or download the TRICARE Costs and Fees Sheet.

"TYA is not an aged-out dependent child's only option after regular TRICARE ends," said Ellis. "Families should explore other coverage options. These may include a parent's employer-sponsored commercial plan, school or university health plans, Medicaid or marketplace options, and more."

Visit TRICARE Young Adult to learn more about the key features of this plan. You can also download the TRICARE Young Adult Fact Sheet for specifics about TYA coverage and getting care. Getting to know your TYA plan will help you make informed choices and take command of your health.