Military Health Plan Now Covers Adult Children

I’m in the military and my 23-year-old son was dropped from the Tricare health insurance program when he graduated from college. I understand the rules have changed regarding coverage for young adults. Can he get back on my policy?

Even though the new health care law required most insurers to offer coverage for adult children up to age 26 on their parents’ policies starting last January, Tricare (the health care coverage for members of the military and their families) did not offer this coverage extension until recently. But now you can sign up to cover your adult children up to age 26, and you can even get coverage retroactively to January 1, 2011, if you act quickly.

Tricare coverage generally ends for adult children at age 21 (or 23 for full-time students). But the new rules let you extend that coverage until the child reaches age 26. Like the new rules for standard health insurance policies, the young adult doesn’t need to be a dependent for tax purposes and doesn’t need to live with the service member. But the young adult does need to be registered with the family in DEERS (the Defense Enrollment Eligibility Reporting System). In addition, young adults cannot be married and can’t be eligible to enroll in a health insurance plan through their own employer (even if they choose not to take their employer’s coverage). If they lose their job and are eligible for extended group health insurance coverage under COBRA, however, they can choose to get Tricare young adult coverage instead (COBRA eligibility doesn’t render them ineligible for this Tricare coverage).

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Unlike the standard health insurance rules, there is a monthly premium specifically for Tricare Young Adult coverage -- $186 per month in 2011. The coverage provides the same medical and pharmacy benefits as Tricare, but with co-payments based on the sponsor’s (parent’s) military status. For example, children of active-duty members pay 15% of the negotiated rate for outpatient care with a network provider, or $16.85 per day for inpatient care with a network provider (with a minimum charge of $25). If they get care with a non-network provider or an overseas provider, they have to pay 20% of the allowable charge for outpatient care, or $16.85 per day for inpatient care (with a minimum charge of $25). Children of retired service members have different, slightly higher cost-sharing levels.

If your son is eligible, you can sign him up for Tricare Young Adult coverage at any time -- you don’t need to wait for a life-changing event or open-enrollment period. And people who had big medical expenses over the past year and didn’t have any insurance during that time have a special opportunity to sign up for retroactive coverage back to January 1, 2011, and get their uninsured medical expenses reimbursed by Tricare. To qualify for retroactive coverage, you must sign up by September 30, 2011, pay the $186 monthly premiums for the full nine months from January 2011 to September 2011, and submit receipts for your uninsured medical expenses. This move can be cost-effective if your child didn’t have insurance for the first part of the year and had uninsured medical expenses topping $1,700.

When deciding whether to buy Tricare Young Adult coverage, your son should compare the cost to the price of buying coverage on his own. In many states, healthy people younger than 26 can generally buy their own coverage for about $100 a month or less, but they might have to pay a higher deductible and co-payments (you can get price quotes for individual health insurance at eHealthInsurance.com). But if you have health issues, or you want more-comprehensive coverage and plan to use in-network providers, these Tricare benefits may be your best bet.

For more information and enrollment forms, see the Tricare Young Adult Web page. For personal-finance advice for military families, see our military families page.