This spring, Tricare coverage will be made available to military dependents up to the age of 26, and that extra coverage will be available retroactively to Jan. 1 this year.
But these dependents will have to pay a premium set high enough to cover the entire cost of the program.
The exact charge is not yet known but unofficial estimates have ranged from $1,400 to $2,400 a year or about $116 to $200 a month.
In debating national health reform in 2009, many in Congress argued that a superior Tricare program should not be impacted in any way. Only later was it noted that military families were left behind on the coverage of dependent children up to age 26. Dependent Tricare coverage still ended when a child turned 21 or, if attending college fulltime, at age 23.
The armed services committees rejected adding young adult coverage as just another subsidized feature of the Tricare benefit. Doing so would have added $300 million a year to the burgeoning cost of military healthcare.
Premiums under the Tricare Young Adult option are “in the process of being approved by DoD leadership,” said Austin Camacho, a spokesman for the Tricare Management Activity headquartered in Falls Church, Va. “In general, the full-cost premiums will be based on the historical cost of Tricare claims for a similarly aged cohort.”
Tricare projects a modest “take rate” the first year of six percent — about 14,000 youth — out of an eligible population of 233,000 dependents.
By contrast, the Department of Health and Human Services estimates that expanded dependent coverage to age 26 under national health reform will make health insurance available to 1.2 million more young adults.
HHS officials admit that expanding dependent coverage out to age 26 does carry significant costs for some civilian families, a relatively small number who are under “non-group” health insurance policies. HHS said enrolling these children — “about 75,000 in 2011 in non-group market of insurance plans” — will raise their annual premiums an average of $2,360 in 2011 and by $2,400 in 2012.
Proponents on Capitol Hill argue TYA still will be more affordable than many commercial health insurance plans for young adults and Tricare will provide more comprehensive coverage.
TYA coverage, at least initially, will be limited to Tricare Standard or Extra. Standard is the military’s fee-for-service option. It has no enrollment fee but families pay a deductible and face cost shares on treatment costs. But they can choose their doctor from an authorized list. Tricare Extra offers discounts for narrowing doctor choices to the Tricare network.
Tricare Prime is the managed care option. It will be available under TYA at some later time, officials said.
To quality for TYA, young adults can’t be married or have access to employer-sponsored health coverage. Applications will be submitted to their regional Tricare contractor. They must agree to pay monthly premiums by credit card or electronic fund transfer from a checking or savings account.
When final regulations are published, dependents who want coverage back to Jan. 1 merely will have to pay back premiums and file retroactive claims. In the interim, they should use only Tricare-authorized providers and save their medical receipts.
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