Tricare Help

It’s true: Affordable Care Act won’t affect your Tricare

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Tricare Help has been hearing from a lot of beneficiaries who are worried about how the ACA will change their coverage. But Tricare is not affected by the new law, and because every version of Tricare, including Tricare for Life, is considered sufficient minimum coverage for the purposes of the ACA’s requirements, Tricare beneficiaries will see no change in their benefit and do not have to do anything in regards to the ACA. Military Times health reporter Patricia Kime has the full story. (Know a worried beneficiary? Pass the link on.)

Didn’t Obama just say Tricare premiums will go down?

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Recently President Obama held a press conference on the Affordable Care Act and said that insurance premiums are dropping as much as 50 percent, and that some insurers were even sending out rebate checks. That’s great news. But then I read that Tricare is raising rates for most insured. Shouldn’t they actually be going down, according to what the president said?

Tricare operates completely independently of the Affordable Care Act, which is concerned only with commercial health insurers, most of which have costs that far exceed those charged by Tricare.

After years of rejecting all calls by the Pentagon to raise Tricare fees, Congress in the past couple of years has allowed very modest increases to take effect in some fees, such as the annual Tricare Prime enrollment fee and some prescription drug co-pays. But again, these are very slight increases; the Prime enrollment fee, for example, cannot rise by more than the annual increase in the military retirees’ cost-of-living adjustment, which is usually no more than a few percentage points in any given year.

On the whole, Tricare remains one of the lowest-cost health benefits plans in the nation.

How will Obamacare affect Tricare for Life?

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I am covered by Tricare for Life after 30 years in the Coast Guard. What is going to happen to all of us retired folks under Obamacare? Will we still have Tricare for Life, or will there be changes?

Many aspects of the Affordable Care Act, sometimes known as Obamacare, have already taken effect. Under that new law, Medicare beneficiaries are still guaranteed their existing Medicare-covered benefits and can still choose their own doctors.
The Affordable Care Act has zero impact on the Tricare portion of Tricare for Life, for the simple reason that Tricare is governed under a completely separate law.

The Pentagon last year proposed to implement a modest annual enrollment fee for Tricare for Life beneficiaries of $200 a year, but Congress rejected that proposal and does not seem inclined to revisit that issue.

So the basic answer to your question: No one has a crystal ball into the infinite future, but at this point there is no evidence to indicate that there will be any reductio

Doesn’t Tricare have to keep children covered until age 26?

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I am retired from the Marine Corps and have twin girls. Recently I received a letter from DoD stating that if my daughters are not full-time college students, they will lose their health care benefits upon turning 21 next year or 23 if they remain full-time students. I thought a law was recently passed that said dependents can remain on their parents’ health care plan until 26. Is the military exempt from this law?

Your daughters will lose eligibility for regular Tricare coverage at the ages you were told. At that time, they may transition into a relatively new program called Tricare Young Adult, or TYA, under which they can continue Tricare coverage until age 26. However, that’s not automatic; TYA requires enrollment and payment of monthly premiums. This year, those premiums are $201 per month for Tricare Prime coverage and $176 per month for Tricare Standard coverage. As of Jan. 1, those costs will drop to $176 per month for Prime and $152 per month for Standard.

TYA provides medical and pharmacy benefits, but it does not include dental coverage.

A couple of other eligibility requirements: The adult dependent children must be unmarried, and they must not have access to other health care coverage, such as through their own employer.

Do I really have to buy the Young Adult Plan for my daughter?

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Under Obama’s health care reform, children can be covered under their parents’ policy as long as the child is single and younger than 26. I have a daughter who just graduated from college. She is 22 and is in the process of looking for a job. I have the family plan with Tricare that costs between $450 to $500 per year. Can my daughter still be covered under this family plan? I spoke with one office and was told that I would have to buy young adult insurance for a fee double what the family plan is now costing me. Which is correct?

Because your daughter has reached her 21st birthday but is no longer enrolled as a full-time student, her only option for Tricare eligibility is under the Young Adult Plan.

If she were to enroll again as a full-time student, her Tricare eligibility could be restored for as long as she was enrolled, but only until she turned 23. Then, as now, she could be eligible only under the Young Adult Plan until reaching age 26.

To officially confirm which Tricare plan your daughter is eligible for, please call the DEERS Support Office, toll-free, at 1-800-538-9552.

Why can’t I just be on family’s plan instead of Tricare Young Adult?

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Q. I don’t understand the Tricare program(s) I am eligible for. I am a 24-year-old unemployed college student, and my father is on active duty. The rest of my family has Tricare Prime. As I read the health care reform law, I should be legally qualified to be added onto the Prime plan. But when I called Tricare, they told me I am eligible for the Tricare Young Adult Plan. This is not my parents’ plan. Why is Tricare not following the law?

The Young Adult program is the Defense Department’s implementation of the new law regarding the extension of dependent children’s eligibility for their parent’s insurance coverage beyond the previous, virtually universal, cut-off age of 19 or 21 in the health insurance industry generally.

The information you received is what the law provides for your extended eligibility, even if it is not exactly, and in all respects, the same plan your parents have.

Tricare is not a health insurance policy or an insurance company. The program now known as Tricare is a federal health benefits program created in 1966 by federal law. It is similar in that respect to Medicare. It is not subject to the laws that govern the insurance industry in any state.

All of Tricare’s operations including eligibility requirements are governed by the federal law enacted by Congress in 1966 that created the program now known as Tricare and the subsequent federal regulation that interprets and implements that law. Federal regulations have the force and effect of law.

Laws seldom spell out in detail exactly what is to be done, when, and by whom. Each agency affected must draft regulations to interpret a law as it applies to that agency’s operations (which are determined by the agency’s enabling legislation; that is, the law that created the agency).

You cannot simply be added to your parents’ Tricare plan because the Defense Department’s interpretation and implementation of the law do not allow it. Because of your age, you are in a different category of beneficiary.

News Update: Tricare Young Adult Program

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Tricare has announced the premiums.

Can I keep Tricare until age 26 if I get married?

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Q. I am 20 years old and a Tricare dependent. I am looking at getting engaged and was wondering what would happen to my dependency. My understanding is that, currently, I will lose my coverage when I turn 21 or when I become married. But I have heard that the new health care extends that to age 26 even if a dependent is married. Is that true?

No; Congress recently passed a law that allows the Defense Department to extend the eligibility of unmarried children until age 26 under certain circumstances. The coverage will require payment of a monthly premium. That amount is yet to be determined.

You can find official information about Tricare’s Young Adult Program here.

When can dependents get Tricare until age 26?

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Q. My daughter is a full-time student, and at age 23 she was dropped from my health coverage. Under the new health care plan, will she qualify for coverage again until 26 years of age?
The new law applies only to commercial health insurance policies and companies.  Tricare, however, is not a health insurance policy or company.  It is a federal health benefits program similar in that respect to Medicare.  Thus, the new law does not apply to it.
An initiative has been introduced to apply that part of the law to the children of active duty and retired members and extend their eligibility to age 26.  At this time, however, such a change is in the hands of Congress, and the old law remains in effect until Congress acts to change it.
If and when Congress approves the initiative, it will be widely publicized.