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As new Tricare contracts are implemented, beneficiaries should anticipate alterations to their military healthcare services, including the enhancement of certain benefits, as stated by military representatives and officials.
Defense Health Agency officials said the new contracts, which went into effect Jan. 1, will provide more efficient referral transfers between the East and West Tricare regions; greater access to highly specialized medical and surgical care; better access to telehealth appointments; and improved choices for beneficiaries, including tools that will help them quickly identify providers with the best outcomes.
Officials announced that the latest round of Tricare contracts aims to enhance healthcare services for the 9.6 million individuals covered by the military health system.
Karen Ruedisueli, the director of health affairs in government relations for the Military Officers Association of America, a nonprofit focused on military advocacy, stated, “I believe that the majority of the changes to the Tricare contracts will occur behind the scenes. After we navigate through the transition period, we are optimistic that the networks will be strong enough to ensure that most military families can continue receiving care from their civilian providers without interruption.”
According to Ruedisueli, the newly established contracts aim to simplify the process for military families seeking specialty care during relocations, which has been a long-term objective for MOAA. These contracts are said to enable Tricare to begin issuing referrals for specialty care to Tricare Prime beneficiaries at their new duty station, even before they depart from their current location during a permanent change of station.
The new agreements will not impact individuals enrolled in Tricare for Life, the U.S. Family Health Plan, or any Tricare health plans available internationally.
The new contracts also include a transition period for referrals and an updated waiver policy.
TriWest will honor unexpired referrals and preauthorizations that were issued by the former West Region contractor, Health Net Federal Services, prior to January 1. These documents will remain valid until June 30 or until their expiration date, whichever occurs first.
Residents of states that have transitioned to the West Region, including Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin, will find that TriWest is now accepting valid referrals and preauthorizations from Humana Military. These will remain valid until they either expire or reach the deadline of June 30, whichever occurs first.
As is customary, beneficiaries of Tricare Prime are required to obtain referrals from their primary care manager (PCM) for any essential medical treatments that the PCM is unable to administer. Preauthorizations involve more detailed evaluations that take place before specific services can be approved for coverage.
The new contracts have also changed the drive-time waiver policy for Tricare Prime beneficiaries in both regions. Those who move to a location that’s more than a 30-minute drive — but less than 100 miles — away from their military hospital or clinic can seamlessly continue to receive care from their current primary care manager. No action is required on the part of the beneficiary who wants to continue with the current PCM, unlike previous requirements.
The beneficiaries will receive a letter informing them that they fall outside the 30-minute driving range. If they do not reply, they can retain their existing Primary Care Manager (PCM), but those wishing to make a change can adhere to the instructions provided in the letter.
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While Humana Military remains the East Region contractor, TriWest Healthcare Alliance is the contractor for the West Region, which now includes beneficiaries living in certain ZIP codes in addition to the six states that moved from the East Region.
In connection with the changes to the West Region contract, beneficiaries making recurring payments must refresh their payment details with TriWest. Officials have pushed back the initial deadline of December 31 to January 15 for beneficiaries participating in Tricare Young Adult, Tricare Reserve Select, and Tricare Retired Reserve plans. Meanwhile, those in Tricare Prime or Tricare Select have until January 30 to comply. This requirement is relevant for individuals who settle enrollment fees or premiums using credit cards, debit cards, or electronic funds transfers.
Some West Region beneficiaries, however, have reported glitches when trying to set up payments with TriWest, Military Times previously reported. TriWest officials have said they are working on website issues and adding staff to their call center to handle increases in call volume.
For over three decades, Karen has reported on military families, quality of life, and consumer matters for Military Times. She is also a co-author of a chapter discussing media representation of military families in the book "A Battle Plan for Supporting Military Families." Prior to this, she gained experience working with newspapers in Guam, Norfolk, Jacksonville, Florida, and Athens, Georgia.
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