TRICARE Young Adult (TYA)

Regular Army: Active 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 2019. 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. The forms will be required to be reported with your 2019 federal tax return. DFAS will provide you with IRS Form 1095 series forms no later than 31 January 2020. 

Eligibility

You may generally purchase TYA coverage if you are all of the following:

  • 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 percent 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 him/her 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 active duty 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'll 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 he or she can't provide

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

  • files claims for you

Premiums :

  • The 2020 monthly premium is $376 per month (through 31 December 2020)

  • 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.

TYA-Prime Table of Cost Shares for Prime Network Copayments for Active Duty Family Members

 

Group A and Group B

Enrollment Fees

$376/month

Deductibles

Deductible

$0


Catastrophic Cap


Catastrophic Cap

Group A: $1000

Group B: $1,044 (TYA Follows Group B)

Health Plan Costs


Outpatient Visit - Primary

Primary: $0

Non-network: POS


Outpatient Visit - Specialty

Network: $0

Non-network: POS


Urgent Care

Network: $0

Non-network: POS


Emergency Services

Network: $0


Laboratory and X-Ray

Network: $0

Non-network: POS


Ambulance Services

Network: $0

Non-network: $0


Ambulatory Surgery (Same Day)

Network: $0

Non-network: POS


Mental Health (Inpatient)

Network: $0

Non-network: POS


Mental Health (Outpatient/Partial Hospitalization) - Primary Care

Network: $0

Non-network: POS


Mental Health (Outpatient/Partial Hospitalization) - Specialty Care

Network: $0

Non-network: POS


Mental Health (Residential Treatment Facility)

Network: $0

Non-network: POS


Clinical Preventive Services

Network: $0

Non-network: POS


Durable Medical Equipment, Prosthetics, and Medical Supplies

Network: $0

Non-network: POS


Home Health Care

Network: $0

Non-network: POS


Hospice Care

Network: $0 (Medical equipment and pharmacy are billed separately)

Non-network: POS


Hospitalization (Inpatient Care)

Network: $0

Non-network: POS


Immunizations

Network: $0

Non-network: POS


Maternity (Delivery/Inpatient)

Network: $0

Non-network: POS


Maternity (Delivery/Birthing Center)

Network: $0

Non-network: POS


Maternity (Home) - Primary

Network: $0

Non-network: POS


Maternity (Home) - Specialty

Network: $0

Non-network: POS


Newborn Care

Network: $0

Non-network: POS


Skilled Nursing

Network: $0

Non-network: POS

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

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

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'll 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 2020 monthly premium is $228 per month (through 31 December 2020). ’

  • 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'll pay:

  • Monthly premiums

  • Annual Deductible

    • Sponsor rank E4 and below: $52 per person, but no more than $104 per Family

    • Sponsor rank E5 and above: $156 per person, but no more than $313 per Family

  • Cost Shares

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

TYA-Select Table of Cost Shares for Active Duty Family Members

Group A and B

Enrollment Fees

Enrollment Fees

$228/ month


Deductibles


Deductible

E1-E4: $52 per individual and $104 per Family

E5 & above: $156 per individual and $313 per Family


Catastrophic Cap


Catastrophic Cap

Group A: $1000

Group B: $1044 (TYA Follows Group B)

Health Plan Costs


Outpatient Visit - Primary

Network: $15

Non-network: 20%


Outpatient Visit - Specialty

Network: $26

Non-network: 20%


Urgent Care

Network: $20

Non-network: 20%


Emergency Services

Network: $41

Non-network: 20%


Laboratory and X-Ray

Network: $0

Non-network: 20%


Ambulance Services

Network: $15

Non-network: 20%


Ambulatory Surgery (Same Day)

Network: $26

Non-network: 20%


Mental Health (Inpatient)

Network: $62

Non-network: 20%


Mental Health (Outpatient/Partial Hospitalization) - Primary Care

Network: $15

Non-network: 20%


Mental Health (Outpatient/Partial Hospitalization) - Specialty Care

Network: $26

Non-network: 20%


Mental Health (Residential Treatment Facility)

Network: $26/day

Non-network: $52/day

Clinical Preventive Services

$0


Durable Medical Equipment, Prosthetics, and Medical Supplies

Network: 10%

Non-network: 20%

Home Health Care

$0

Hospice Care

$0 (Medical equipment and pharmacy are billed separately)


Hospitalization (Inpatient Care)

Network: $62

Non-network: 20%

Immunizations

$0


Maternity (Delivery/Inpatient)

Network: $62

Non-network: 20%


Maternity (Delivery/Birthing Center)

Network: $26

Non-network: 20%


Maternity (Home) - Primary

Network: $15

Non-network: 20%


Maternity (Home) - Specialty

Network: $26

Non-network: 20%


Newborn Care

Network: $0

Non-network: 20%


Skilled Nursing

Network: $26

Non-network: $52

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

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

*NOTE : Newborn care is not covered unless the father of the Child is a uniformed Service Member.

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, he or she 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:
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: 27 January 2020