TRICARE Young Adult

By Brian P. Smith
Triwest Health Care Alliance

Military families have a new TRICARE Prime option for young adults without health care coverage.

TRICARE Young Adult (TYA) Prime gives eligible family members TRICARE Prime medical (and pharmacy) coverage with low out-of-pocket costs for a $201 monthly premium.

Military family members who are not married, who have “aged out” of other TRICARE eligibility (up to age 26), and who have a TRICARE-eligible sponsor are eligible to purchase TYA coverage.

Does that sound like you? TYA enrollees can choose either TYA Standard or TYA Prime coverage, based on eligibility. The choice will determine your monthly premium, out-of-pockets costs, and how you access care. Each TYA program allows access to the TRICARE pharmacy benefit. Complete information, along with the application form, is available at TRICARE.mil/TYA.

TYA Prime Features:

• Little to no out-of-pocket costs for care
• $201 monthly premium for 2012
• Sponsor must be eligible for TRICARE Prime (or TRICARE Prime Remote)
• Coverage is available in those Prime service areas where TRICARE Prime is available
• Open enrollment, but coverage start date depends on when the application is received
• Access care from a primary care manager, TRICARE network providers, and at military hospitals
• Referrals needed for most specialty care

TYA Standard Features:

• Annual deductible and cost-shares
• $176 monthly premium for 2012
• Sponsor must be eligible for TRICARE (and enrolled in TRICARE Reserve Select or TRICARE Retired Reserve, if eligible)
• Continuous and open enrollment
• Access care from any TRICARE-authorized provider
• No referrals needed

Premium Payments

Enrollment in TYA requires paying the monthly premiums by automatic recurring payments. You can set up payments through either credit or debit card or through a monthly electronic funds transfer from a bank account. Premiums can change each year on Jan. 1.

Changing Plans

Current TYA Standard enrollees can change their enrollment to TYA Prime, if they are eligible. You’ll fill out and submit a new TYA Application. Your monthly premium will change; update your automatic payment information with your regional contractor, if needed.