Q&A: What To Know as New TRICARE Contracts Begin in 2025 (2024)
Coast Guard Lt. Coty Hall, command intelligence officer at Sector Houston-Galveston, and Jenna Hall, Sector Houston-Galveston’s ombudsman and winner of the 2022 Wanda Allen-Yearout Ombudsman of the Year Award, and Adilyn, the couple’s 6-month-old daughter, pose for a portrait at the sector, April 13, 2023. Hall previously won the award in 2019 for her work as Sector Los Angeles-Long Beach’s ombudsman. (U.S. Coast Guard photo by Petty Officer 1st Class Corinne Zilnicki)
5/15/2024By:TRICARE Communications
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TRICARE Health Plan | Information for Patients: About TRICARE | Defense Enrollment Eligibility Reporting System
FALLS CHURCH, Va. – New TRICARE managed care support (MCS) contracts, known as T-5, will start on Jan. 1, 2025. MCS contractors manage administrative support services for the TRICARE benefit. This includes managing enrollment services, maintaining civilian healthcare networks, operating call centers, and processing TRICARE claims. The new contracts will improve health care delivery, quality, and access for beneficiaries living in the United States.
The Defense Health Agency (DHA) and the two regional contractors in the East Region and West Region are currently transitioning to these new contracts to ensure health care delivery is ready for all beneficiaries on Jan. 1, 2025.
“We are committed to keeping all of our military families informed about your health plan, your choices, and ensuring a seamless transition to new contractors,” said Lt. Gen. Telita Crosland, director of the DHA.
Here’s what you should know as the DHA transitions to the new contracts in 2025.
Q: Will these changes affect me?
A: The new contracts will affect you unless you have TRICARE For Life, the U.S. Family Health Plan, or a TRICARE Overseas health plan. The contractors for these plans will stay the same. Your dental and vision coverage isn’t affected by this change either.
Q: What do I need to do now?
A: The only thing you need to do now is check the Defense Enrollment Eligibility Reporting System (DEERS) to confirm your information is current. This will help make sure you don’t miss important communications about your TRICARE benefit and upcoming changes.
Q: When do changes take effect?
A: How you get your health care won’t change for the rest of 2024. The same regional contractor will continue managing your health plan through Dec. 31, 2024:
Starting in fall 2024, you’ll receive communications from DOD and the new TRICARE contractors for each region. They will start delivering health care on Jan. 1, 2025.
East Region: Humana Military. This is the current contractor, but six states currently in the East Region will move to the West Region.
West Region: TriWest Healthcare Alliance Corporation. This is the new contractor.
Not sure which region you’re currently in? Go to TRICARE Regions to learn more.
Q: What changes can I expect?
A: On Jan. 1, 2025, there will still be two TRICARE regions in the United States. However, six states that are currently in the East Region will move to the West Region.
These states are:
Arkansas
Illinois
Louisiana
Oklahoma
Texas
Wisconsin
In total, the six states changing regions will affect about 1.1 million eligible beneficiaries.
Beneficiaries in all states will receive updates later this year. You’ll learn how the transition will happen—and any actions you need to take—so your TRICARE benefits continue uninterrupted.
Q: What improvements does the new contract offer?
A: The new contracts include a commitment to help you identify top-performing providers and improve access to highly specialized care.
“We’re excited about how T-5 improves choice and offers more flexibility to our military beneficiaries. It’ll help us deliver on our commitments to excellent care and improved military readiness,” Crosland added.
Every change will help support you by providing:
More efficient referral transfers between the two regions
Greater access to highly specialized medical and surgical care (such as organ transplants)
Improved choice, including virtual value network tools that will help you quickly identify providers with best outcomes
Better access to telehealth appointments
Some changes to the TRICARE health plan will happen behind the scenes. These changes will include:
Improving how military hospitals and clinics and civilian care work together to enhance patients’ experience
Supporting innovation and health care industry best practices
Q: How can I learn more?
A: You’ll hear more about any actions you may need to take later this year. In the meantime, stay tuned for more information about T-5 by signing up for email alerts from TRICARE.
Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.
New TRICARE managed care support (MCS) contracts, known as T-5, will start on Jan.1, 2025. MCS contractors manage administrative support services for the TRICARE benefit. This includes managing enrollment services, maintaining civilian healthcare networks, operating call centers, and processing TRICARE claims.
East Region: Humana Military. This is the current contractor, but six states currently in the East Region will move to the West Region. West Region: TriWest Healthcare Alliance Corporation. This is the new contractor.
Humana Military is the current TRICARE East Region contractor. When the new TRICARE contract begins on Jan. 1, 2025, Humana Military will still be the East Region.
A new TRICARE West Region contract is currently scheduled to start Jan. 1, 2025. With this, the West Region contractor will change from Health Net Federal Services, LLC (HNFS) to TriWest Healthcare Alliance (TriWest).
Humana Government Business, the incumbent contractor for Tricare's East Region, will continue in that role under a new deal worth up to $70.8 billion. The new contracts for the two regions have a potential combined value of $136 billion over nine years.
If you're on active duty, you have to enroll in TRICARE Prime. All others can choose to enroll in TRICARE Prime or TRICARE Select. TRICARE Prime offers fewer out-of-pocket costs than TRICARE Select, but less freedom of choice for providers. If you have other health insurance.
There are TRICARE-related apps to help you manage your health and healthcare needs from your mobile device. You can use an app to find a provider, check your eligibility, make payments, manage your prescriptions, etc. To download an app, visit the Download a Mobile App page.
Effective Mar. 1, 2024, if you fill your specialty drugs through TRICARE Home Delivery, you will start to receive expanded specialty pharmacy services from Accredo Health Group, Inc., (Accredo) – as part of the Express Scripts, Inc (ESI) contracted TRICARE network. Learn more.
The problem stems from the fact that most Tricare managed care support contractors have negotiated physician reimbursem*nt rates that are even lower than those paid by Medicare. Unhappy with their fees, some major health care provider groups have simply dropped out of the system.
A federal judge has ruled in favor of the U.S. Defense Health Agency (DHA) in a lawsuit filed by Health Net Federal Services (HNFS) over the agency's decision to award the TRICARE West region managed care support contract to TriWest Healthcare Alliance.
Humana Military, a wholly-owned subsidiary of Humana Inc., partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families in the East Region.
If you live in the TRICARE East Region, Humana Government Business (Humana Military) will administer your health plan and provide TRICARE coverage. If you live in the TRICARE West Region, TriWest Healthcare Alliance Corporation will administer your health plan and provide TRICARE coverage.
Committed to creating better health outcomes and simplified experiences. Humana Military is dedicated to offering the finest healthcare available, with a simplified approach to service and care. Self-service empowers your experience with quicker and more efficient options.
TRICARE brings together military and civilian health care professionals and resources to provide high-quality health care services. TriWest serves the health care needs of the military and Veteran communities by managing contracts such as the DOD's TRICARE program and VA's Community Care Network.
The award, announced in December 2022, is worth up to $65.1 billion over nine years. Humana Government Business, the incumbent contractor for Tricare's East Region, will continue in that role under a new deal worth up to $70.8 billion.
In December 2022, the Department of Defense (DOD) awarded TriWest Healthcare Alliance (TriWest) the contract to administer its next generation TRICARE West Region contract, commonly referred to as “T-5.” Health care delivery is expected to start under T-5 on January 1, 2025.
A new TRICARE West Region contract is currently scheduled to start Jan. 1, 2025. With this, the West Region contractor will change from Health Net Federal Services, LLC (HNFS) to TriWest Healthcare Alliance (TriWest).
In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including mental disorder), injury, or for the diagnosis and treatment of pregnancy or well-child care.
“For example, if you want a primary care manager to coordinate your care, TRICARE Prime might be right for you. If you would prefer more flexibility when picking specialty providers, consider TRICARE Select.”
TRICARE Online. What is MHS GENESIS? MHS GENESIS (MHSG) is the new electronic health record for the Military Health System (MHS) and provides enhanced, secure technology to manage your health information.
Tricare is the U.S. military's health care program and functions as government-managed health insurance. Tricare's various coverage plans provide health care for millions of current and former service members and their families. Tricare is managed by the Pentagon's Defense Health Agency.
TRICARE is the health care program for service members, retirees and their families worldwide. TRICARE provides comprehensive coverage, health plans, special programs, prescriptions and dental plans.
In December 2022, the Department of Defense (DOD) awarded TriWest Healthcare Alliance (TriWest) the contract to administer its next generation TRICARE West Region contract, commonly referred to as “T-5.” Health care delivery is expected to start under T-5 on January 1, 2025.
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Coast Guard Lt. Coty Hall, command intelligence officer at Sector Houston-Galveston, and Jenna Hall, Sector Houston-Galveston’s ombudsman and winner of the 2022 Wanda Allen-Yearout Ombudsman of the Year Award, and Adilyn, the couple’s 6-month-old daughter, pose for a portrait at the sector, April 13, 2023. Hall previously won the award in 2019 for her work as Sector Los Angeles-Long Beach’s ombudsman. (U.S. Coast Guard photo by Petty Officer 1st Class Corinne Zilnicki)