Children age 18 to 21, coverage by TriCare (military plan)

I have three kids ages 18, 19, and almost 21.  The entire family is under Tricare Prime insurance policy (retired military benefits plan).

Child #1 (18 year-old) is still in college and will continue to be full-time student for (hopefully) several years but is no longer living at home.  Her father and I are still providing support (under 20%) for living, college, and other expenses. 

Child #2 (19-year-old) finished a trade-school certification program, but is still studying for a ‘certification’ (national exam) to enter a trade field.  We provided 50%+ of living expenses, support, etc., while he lived outside our home (roommates, etc.).  He recently moved out of state.

Child #3 (almost 21-year-old) flunked out of college in first semester, continued to live at home.  We are providing 75%+ of living expenses, accommodations, etc.  She is working full-time (minimum wage), and may enter the military service once accepted via recruiting office within the next year (hopefully even sooner!).

My questions: Under the Affordable Care Act (ObamaCare):

1) Are all three children eligible, and will they remain eligible, for coverage for all medical benefits until they turn 26, regardless of whether they are still in school or living at home?

2) Has the child who is no longer in school ‘lost’ their eligibility for coverage under the Tricare program since he moved out of state and completed his official schooling, even though he is still studying for certification exam and parents are no longer covering 50%+ of their living expenses?

3) Is the child who is no longer going to school but living at home still eligible for coverage, even though she’s about to turn 21, and parents still covering 50%+ of living expenses?

Trying to Empty The Nest

Dear Trying to Empty The Nest,

You are correct that under the Affordable Care Act, private health insurance plans must offer coverage to children up to age 26.  Tricare is not a private health insurance plan and is not required to do this.  Instead, Tricare has a Young Adult Plan, which has some additional rules attached. 

Child #3: When your almost 21-year-old turns 21, she can qualify for Tricare’s Young Adult Plan assuming she is

  • Unmarried
  • At least age 21 but not yet 26 years old
  • Not offered an employer-sponsored health plan by her own employer. 
  • Not otherwise eligible for Tricare.  (She will obviously become eligible for Tricare if she enlists in the military.)

The Young Adult Plan has a separate sign up and separate monthly cost. 

Child #2: Your 19-year-old can stay on your plan as a dependent until he turns 21.    At age 21, the “regular” Tricare coverage ends. He can then be covered by the Young Adult Plan, if he is unmarried, etc. as described above. 

Child #1: Your 18-year-old can also be on your plan as a dependent.  He can stay on your plan until age 23, if he is still in school.  Once he turns 23 – even if he has not graduated – he would get coverage under the Young Adult Plan.

 Good luck and best wishes for emptying that nest!

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.