Understand Your TRICARE Young Adult Plan

In case you are worried about your regular TRICARE coverage as you will turn 21 years old- let us tell you, there is nothing to worry about. You may no longer be eligible for regular TRICARE coverage- but you would be may still be eligible for TRICARE Young Adult options. 

TYA is a premium-based health care plan. There are two options for TYA—TRICARE Young Adult Prime and TRICARE Young Adult Select. Your sponsor’s status and your geographic location determine whether you can purchase either TYA Prime or TYA Select. As highlighted in the TRICARE Young Adult Program Fact Sheet, TYA Prime is available in assigned geographical areas, and TYA Select is available globally. 

“When kids age out of TRICARE Prime or TRICARE Select, TYA is a great option for health care coverage if, for example, they don’t have coverage from an employer,” said Mark Ellis, chief of the Policy and Programs Section of the TRICARE Health Plan at the Defense Health Agency. “TYA helps kids transition into adulthood and into having independent health insurance.”

Who can enroll in TYA?

Young adults must show as eligible in the Defense Enrollment Eligibility Reporting System (DEERS) to register in TYA. Keeping DEERS up to date is essential to get your TRICARE privileges.

You can purchase TYA coverage if you’re:

  • An unmarried, adult child of an eligible uniformed service sponsor
  • At least age 21, but not yet age 26 (see further restrictions)
  • Ineligible for an employer-sponsored health plan under your employment as defined in TYA regulations
  • Not otherwise eligible for other TRICARE program coverage
  • Not a uniformed service sponsor (for example, an active duty service member or a member of the Selected Reserve)

Anyone who fits for TYA may enroll in TYA Select. However, those who are only eligible for TYA Prime include:

  • Children of active-duty sponsors in all U.S. locations and all overseas areas, if command-sponsored
  • Children of retired sponsors if they live in a Prime Service Area

If you’re TYA Prime-eligible and live in an area where the US Family Health Plan (USFHP) is offered, you may choose USFHP for your TYA Prime option.

How do you get care with TYA?

How you get care relies on if you opt TYA Prime or TYA Select. TYA coverage covers medical and pharmacy benefits, but not dental coverage.

If you have TYA Prime, you have access to care through an assigned military or civilian primary care manager. USFHP enrollees get care through their primary care provider. TYA Select works just like TRICARE Select so that you can visit any TRICARE-authorized provider. 

All TYA beneficiaries are eligible for care at military hospitals and clinics, but TYA Select beneficiaries have access only when space is available. And TYA Prime beneficiaries enrolled in the USFHP can’t access care at military hospitals and clinics.

What are the costs of TYA?

To participate, you must pay monthly premiums. TYA premiums get adjusted each year. They don’t count toward your deductible or catastrophic cap. Costs depend on sponsor status, beneficiary group, and TRICARE plan.

With TYA Prime, you’ll pay monthly premiums and TRICARE Prime copayments, if required. Any care received without a referral from a primary care manager is subject to point-of-service fees.

With TYA Select, you’ll pay monthly premiums, deductibles, copayments, and cost-shares. Costs vary depending on the sponsor’s military status.

For specific costs, both TYA Prime and TYA Select follow Group BClick to close you, or your sponsor’s initial enlistment or appointment occurs on or after January 1, 2018, are in Group B. cost-shares, deductibles, and catastrophic caps. Use the TRICARE Compare Costs Tool to view TYA costs or download the TRICARE Costs and Fees Sheet.

“TYA is not an aged-out dependent child’s only option after regular TRICARE ends,” said Ellis. “Families should explore other coverage options. These may include a parent’s employer-sponsored commercial plan, school or university health plans, Medicaid or marketplace options, and more.”

Tricare Admin

Add comment