Tricare Help: Is Tricare violating the health reform law? - Getting out, military health issues - Navy Times

Tricare Help: Is Tricare violating the health reform law?

Q. I don’t understand the Tricare program or programs 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 won’t Tricare obey the law?

A. 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, cutoff age of 19 or 21 in the broad health insurance industry.

The information you received is what the law provides for your extended eligibility, even if it is not exactly 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 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. 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 DoD’s interpretation and implementation of the law do not allow it. Because of your age, you are in a different category of beneficiary.

Q. My husband is deployed and we just had a baby. Can I enroll her in DEERS, or does he have to?

A. It is the military sponsor’s responsibility to register his family with the Defense Enrollment Eligibility Reporting System and with the military service. You should call DEERS at 800-538-9552 for guidance pertaining to your situation with an absent sponsor.

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