TRICARE Young Adult (TYA)

Army National Guard: Active Duty Under Title 10 USC or Title 32 USC (Full-Time National Guard Duty)

Benefit Fact Sheet

Summary

The TRICARE Young Adult (TYA) Program is a premium-based individual-only health care plan available for purchase by qualified adult Children of Service members who have aged out of regular TRICARE Family coverage. TYA offers Prime and Select coverage levels worldwide. TYA includes medical and pharmacy benefits but excludes dental coverage.

DFAS will provide IRS Form 1095-C to all U.S. military members, and IRS Form 1095-B to all Retirees, Annuitants, former Spouses and all other individuals having TRICARE coverage during all or any portion of tax year 2022. An IRS Form 1095 documents you (and your Family members, if applicable) have the minimum essential coverage. These forms will document the information that DFAS will provide to the IRS on yourself and your authorized Family members. According to the IRS, these forms are not required to prepare or file income tax returns but will be available via myPay no later than 31 January 2023.

Eligibility

You may generally purchase TYA coverage if you are all of the following: Young adults in a group with arms around each other

  • A dependent of a TRICARE-enrolled eligible Service member

  • Unmarried

  • At least age 21 but not yet 26 years old

    • If enrolled in a full course of study at an approved institution of higher learning and your sponsor provides more than 50% of your financial support, your eligibility may not begin until age 23 or upon graduation, whichever comes first.

  • Not eligible to enroll in an employer-sponsored health plan based on your own employment.

  • Not otherwise eligible for TRICARE coverage

TYA Program and the Affordable Care Act: The Affordable Care Act, also known as the Health Care Reform Law, requires that individuals maintain health insurance or other coverage that meets the definition of "minimum essential coverage" beginning in 2014. If purchased, TYA is considered minimum essential coverage. However, adult-age dependents are encouraged to evaluate all healthcare coverage options after aging out of the Sponsor's TRICARE coverage. To assess other healthcare coverage options before purchasing TYA, visit https://www.healthcare.gov.

Benefit Highlights

TYA Program Enrollment: TYA offers open enrollment and may be purchased at any time. After enrolling in TYA, the beneficiary and sponsor must visit a uniformed services identification (ID) card issuing facility to obtain an ID card. Two forms of ID are required - one must be an unexpired government-issued ID card with a picture. For more information on DoD ID card locations click here.

NOTE: If the eligible adult Child is not already in the Defense Enrollment Eligibility Reporting System (DEERS), the sponsor must add them to the system before starting the application process.

There are four ways to enroll for the TYA Program:

  • Online

  • Call the Regional Contractor

  • Fax enrollment to Regional Contractor

  • Mail enrollment to Regional Contractor

Please click here to visit the TYA Program Enrollment Page for details and specific instructions.

TYA Program Options and Costs: TYA Program costs for adult Children of active-duty Service members are based on three things:

  • The option chosen (TYA-Prime or TYA-Select)

  • Your Sponsor's duty location (CONUS or OCONUS). If you are applying for coverage overseas, you will need proof of command-sponsorship from your parent Service member

  • Where you will get care (i.e., network vs. non-network).

NOTE: TYA-Prime members have the same priority for care at military hospitals and clinics as other TRICARE Prime members. TYA-Select members may only be seen for care at military hospitals and clinics on a space available basis, in which case, the cost for care is usually $0.

TYA-Prime:

Overview : Children of activated (more than 30 days) Army National Guard sponsors in all U.S. locations and in all overseas areas (if command-sponsored) and Children of retired sponsors only in Prime service areas are eligible for TYA- Prime. The TRICARE Young Adult-Prime Option works the same as TRICARE Prime. You will have an assigned primary care manager (PCM) who provides most of your care:

  • They will be a military or network provider Find a Provider

  • refers you to specialists for care they cannot provide

  • works with your regional contractor for authorization and to find a specialist in the network

  • files claims for you

Premiums:

  • The 2023 monthly premium is $570 per month (January 1 - December 31)

  • When you first enroll, you will pay two months' premium payment by check, money order, cashier's check, or credit/debit card. After that, premiums are paid automatically by an electronic funds transfer (EFT) or recurring credit/debit card payment.

Deductibles / Cost Shares: For Active Duty Sponsors

  • You pay nothing out-of-pocket

  • Unless you get care without a referral, then you will pay point-of-service charges.

Group A: Sponsor entered uniform service before 1/2/2018

Group B: Sponsor entered uniform service on or after 1/2/2018

For more information on TRICARE Young Adult-Prime Option, please visit: https://tricare.mil/Plans/HealthPlans/TYA

Please visit https://tricare.mil/Costs/Compare to find your TRICARE Young Adult-Prime costs, including copayments, enrollment fees, and payment options effective January 1, 2023.

TYA-Select:

Overview : All dependent adult Children who qualify for TRICARE Young Adult can select the Select Option. The TRICARE Young Adult-Select Option works just like TRICARE Select:

  • Visit any TRICARE-Authorized Provider (An authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network) Find a Provider

  • If you see a network provider, you will pay less out of pocket and the provider will file claims for you

  • You do not need a referral for any type of care but some services may require prior authorization.

Premiums:

  • The 2023 monthly premium is $291 per month (January 1 - December 31)

  • When you first enroll, you will pay two months' premium payment by check, money order, cashier's check, or credit/debit card. After that, premiums are paid automatically by an electronic funds transfer (EFT) or recurring credit/debit card payment.

Deductibles / Cost Shares: To participate, you will pay:

  • Monthly premiums

  • Annual Deductible

    • Sponsor rank E4 and below: $60 per person, but no more than $121 per Family

    • Sponsor rank E5 and above: $182 per person, but no more than $365 per Family

  • Cost Shares

    • Cost sharing begins after you meet the annual outpatient deductible each fiscal year.

Group A: Sponsor entered uniform service before 1/2/2018

Group B: Sponsor entered uniform service on or after 1/2/2018

For more information on TRICARE Young Adult-Select Option, please visit: https://tricare.mil/Plans/HealthPlans/TYA

Please visit https://tricare.mil/Costs/Compare to find your TRICARE Young Adult-Select costs, including copayments, enrollment fees, and payment options effective January 1, 2023.

*NOTE: Expectant mothers enrolled in a TYA program option receive maternity care for the duration of their pregnancy. However, the newborn will not be covered by TRICARE, unless the newborn’s other parent is a sponsor or the newborn is adopted by a sponsor.

Disenrollment: Members may choose to end TYA coverage at any time by completing the fields related to terminating coverage on the TRICARE Young Adult Application and submitting it to their regional contractor ( West, East and Overseas ). If the member decides to end TYA coverage, they will be locked out for one year following the date of termination. There will be no lockout if the coverage is terminated because of employer-sponsored coverage. Coverage is also terminated because of nonpayment or a change in status. Nonpayment results in a 12-month TYA purchase lockout. TYA coverage ends when any of the following occurs:

  • Member reaches age 26

  • Member is married

  • Member becomes eligible for an employer-sponsored health plan

  • Member gains other TRICARE coverage

Member's sponsor ends TRICARE coverage or loses eligibility for TRICARE

Additional Information

For more information, visit the TRICARE Young Adult web site:
https://tricare.mil/Costs/HealthPlanCosts/TYA.aspx

To view and download the TYA Program Fact Sheet:
https://www.tricare.mil/~/media/Files/TRICARE/Publications/FactSheets/TYA_FS.pdf

To visit the TRICARE Homepage and Regions, visit the following pages:

TRICARE Homepage:
https://tricare.mil/

TRICARE East Region:
https://www.humanamilitary.com/

TRICARE West Region:
https://www.tricare-west.com/

Document Review Date: 30 January 2023