TRICARE, the Affordable Care Act, and you

  • Published
  • By 412th Medical Group
EDWARDS AIR FORCE BASE, Calif. --  .

Question: Do TRICARE beneficiaries meet health care requirements established by the Affordable Care Act, also known as the health care reform law?

Answer: In most instances, yes.

The Affordable Care Act requires individuals to maintain basic health care coverage called minimum essential coverage. This is the type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage programs.

If you're using any of the following health plans, you have the minimum essential coverage required by the health care reform law:
  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Standard and Extra
  • TRICARE Standard Overseas
  • TRICARE For Life
  • TRICARE Reserve Select (if purchased)
  • TRICARE Retired Reserve (if purchased)
  • TRICARE Young Adult (if purchased)
  • US Family Health Plan
Unless you're considering other health coverage, you don't need to take any action at this time.

What about Transitional Health Plans? You also have minimum essential coverage if you are covered by either of these transitional health plans:
  • Transitional Assistance Management Program (premium-free, 180 days)
  • Continued Health Care Benefit Program (if purchased, 18-36 months)
Individuals only eligible for care at military hospitals and clinics and not covered by any other TRICARE plan (as listed above), do not meet minimum essential coverage requirements.

Starting January 1, 2014, if someone doesn't have a health plan that qualifies as minimum essential coverage, he or she may have to pay a fee that increases every year: from 1% of income (or $95 per adult, whichever is higher) in 2014 to 2.5% of income (or $695 per adult) in 2016. The fee for children is half the adult amount. The fee is paid on the 2014 federal income tax form, which is completed in 2015. People with very low incomes and others may be eligible for waivers.

For more information on TRICARE and the Affordable Care Act check out these websites:

http://tricare.mil/Welcome/About/MEC.aspx?sc_database=web

https://www.healthcare.gov/