This spring, though an exact date is not yet set, Tricare coverage will be made available to young adult military dependents up to age 26, and that extra coverage will be available retroactively to Jan. 1 of 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.
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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 health care.
In debating national health reform in 2009, opponents argued that a superior Tricare program should not be impacted. Only later was it noted that military families were left out on the coverage of dependent children to age 26. Dependent Tricare coverage still ended when a child turned 21 or, if attending college full time, at age 23.
With passage of the Affordable Care Act, some health insurance plans began last summer to offer children coverage up to age 26. Others had to do so by mid-September or by this month, the next open season for beneficiaries -- such as federal civilian employers -- to choose health insurance plans.
The cost of coverage for children up 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 very visible to the military.
Premiums under the Tricare Young Adult option are "in the process of being approved by (Department of Defense) 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."
Tricare projects a modest "take rate" the first year of 6 percent -- about 14,000 youth -- out of an eligible population of 233,000 dependents.
By contrast, the Department of Health and Human Services estimates that expanded dependent coverage to those age 26 under national health reform will make health insurance available to 1.2 million more young adults.
Most of these families are under large group plans. Health and Human Services estimates that adding these children has bumped premium costs by an average of 0.7 percent, assuming the costs are spread across all plan participants. That means an increase in premiums of roughly $62 to $149 a year.
Congress didn't have the same option of spreading the cost of dependent coverage to age 26 across the entire military community, in part because parents who are active duty members now pay nothing for their health care and no one wanted to see that changed.
Even Health and Human Services officials concede that expanding dependent coverage to age 26 does carry significant costs for some civilian families, a relatively small number who are under "non-group" insurance policies.
"To a large extent, premiums in the non-group market are individually underwritten, and ... most of the premium cost will be borne by the parents who are purchasing the policy to which their child is added," Health and Human Services officials said. That situation echoes what military families will face.