Coverage extension comes at price

This spring, though an exact date is not yet set, TRICARE coverage will be made available to young adult military dependents out to the age 26, and that extra coverage will be available retroactively to Jan. 1 this year.

But for this expansion in TRICARE coverage, by as much as three to five years, these young adult 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.

The bottom line is that Congress didn’t achieve for military families what was gained for other American families, at least on adult dependent coverage, through the Patient Protection and Affordable Care Act.

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.

In debating national health reform in 2009, opponents had 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 out to age 26. Dependent TRICARE coverage still ended when a child turned 21 or, if attending college fulltime, at age 23.

With passage of the Affordable Care Act, some health insurance plans began last summer to offer children coverage out to 26. Others had to do so by mid-September or by this January, the next open season for beneficiaries, like federal civilian employers, to choose from among health insurance plans.

The cost of children coverage out to age 26 has been transparent to beneficiaries under most civilian insurance plans though it’s a safe bet they have begun to pay for it. But the cost will be visible to the military.

Premiums under the TRICARE Young Adult (TYA) 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.”

Some military associations have blasted the premiums expected under the TYA program. 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.

To quality for TYA, young adults can’t be married or have access to employer-sponsored health coverage.

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.

RAISING TRICARE FEES — Defense Secretary Robert Gates will ask Congress one more time to approve a “modest” raise in TRICARE fees for working-age military retirees, which would be the first increase in 15 years.

Gates only briefly outlined of his plan for TRICARE while announcing a lengthy series of department cost-savings initiatives, organization reforms and program cancellations to impose tighter controls on defense spending.

But Gates wants fees raised for retirees under age 65 and their families.

He also wants their TRICARE fees raised automatically in future years to keep pace with medical inflation.

He noted that these retirees drawing “full pensions” while working in second careers and many are turning down employer-provided health insurance to use TRICARE. Meanwhile, federal civilian and private sector employees have seen health insurance costs “rise dramatically.”

Gates said his plan for health care, to be unveiled in February, would save the department nearly $7 billion over the next five years.