Affordable Care Act is not for military families


Our oldest son is approaching his college graduation day, the expiration of his last ID card and the end of the military family status he’s had since birth. Soon he will be independent, no longer a military dependent. Of course, that does not mean his father and I are unconcerned about his future or his health care.

When President Obama signed the Patient Protection and Affordable Care Act into law in 2010, I was interested in the provision that requires health insurers to extend family coverage to adult children.

Under the Affordable Care Act, civilian insurers are required to include adult children up to age 26 – regardless of marital or employment status – on family policies. In many cases the companies are not allowed to charge more for that additional coverage.

However, as we’ve learned, none of the Affordable Care Act applies to military families. Because Tricare was shielded from any changes wrought by the new health care regulations, the organization that provides health insurance to military families was not required to extend health care benefits to adult children.

 The National Defense Authorization Act of 2011 did create a Tricare option for young adult children of military families but – unlike civilian coverage – not without cost. Tricare Young Adult, which extends coverage to military offspring up to age 26, requires monthly premiums of $152 for “Standard” coverage and $176 for “Prime.” These are available to military children up to age 26, as long as they are unmarried and not eligible for insurance through an employer.

The already high cost to the government for military health care, coupled with federal budget concerns prompted Congress to decide that young adult coverage for military families must be self-sustaining, in other words, paid by those insured. Civilian companies are now required by law to bear the cost of extended young adult coverage for civilian families. For Tricare coverage, whatever military families do not pay would be subsidized by the government.

Admittedly, I was disappointed when I learned that this coverage would not be as cheap and easy for us as it is for civilian families. But to put it in perspective, civilian families pay thousands of dollars yearly for health insurance. Our Tricare coverage is not free, it is earned, but for the most part, active duty military members and families pay far less out of pocket for health care than their civilian counterparts.

And this is coverage for our adult children, emphasis on the adult. My husband and I will help our children all we can, but there has to be a limit to how much Uncle Sam owes them – and us.

To find out more about young adult coverage for military families, I visited the Tricare office at my military treatment facility to get the necessary paperwork for the application process. I went online to read more and found that since the program has been evolving since its inception, not all the available information is in agreement.

After a couple of phone calls to the DEERS Support Office and a regional Tricare information line, I gained some understanding of the eligibility requirements and the application process.

First, the sponsor has to be eligible for and enrolled in Tricare. This includes active duty, retirees and reservists in various programs.

The child must be:

* Between 21 and 26 years old

* Unmarried

* Enrolled in the Defense Enrollment Eligibility Reporting System: Military dependents remain enrolled in DEERS until after they are 26, so no new enrollment is needed. For example, my son will still be enrolled in DEERS, even when his last ID card expires next month.

* Not otherwise eligible for Tricare coverage (for example, still in college or in military service)

* Not eligible for insurance through his or her own employer

Additionally, for Tricare Young Adult Prime, the sponsor must be enrolled in Tricare Prime, and the child cannot reside more than 40 miles from a military treatment facility or from a base closure site. Otherwise, these individuals must use Tricare Young Adult Standard.

None of Tricare’s coverage for young adults includes dental care or Tricare Overseas, but parents serving overseas can get coverage for their adult children 26 and under who live in the U.S.

Applications for young adult coverage are available online or at Tricare Service Centers. When complete, they must be mailed or faxed to the Tricare regional office serving the area where the adult child lives, along with two months of premium payments in advance. A payment plan for subsequent payments is set up at that time.

After the form is processed, the applicant will receive a “welcome letter.” The applicant must take that letter and two forms of photo identification, one of which must be an unexpired government-issued identification, to a military installation to get an ID card designated for medical benefits only.

Even the person I spoke to on the Tricare information line was not sure whether the sponsor is required to be present for the young adult to get this special ID, but it can’t hurt. At the very least, I’d suggest taking along proof of DEERS enrollment. As for most things in military life, always carry more paperwork than you think you’ll need.

The program is still evolving, and some information on the website and printed material is obsolete. I suggest talking to a Tricare representative for the most up-to-date information.

 “When you get ready to enroll your son, you should probably call again,” the operator on the Tricare information line told me. “This is Tricare, and things are always changing.”

More information is available at http://www.tricare.mil/Welcome/Plans/TYA.aspx.

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