TRICARE Contract Changeover: After 6 Months of Challenges, What's Next?

MOAA expressed concerns about the next-generation TRICARE managed care support contracts, known as T-5, well before the changeover took effect on Jan. 1 of this year – and we will continue to seek solutions and accountability for the many problems beneficiaries have faced.

The T-5 transition took many forms, affecting many beneficiaries. More than 1.5 million TRICARE users in six states – Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin – moved from the TRICARE East Region to the West Region, while all West Region beneficiaries changed contractors, from HealthNet Federal Services to TriWest. Humana Military retained the redefined East Region but changed claims processors.

[UPDATED MONTHLY: MOAA's TRICARE Toolkit]

Since January, MOAA has provided direct assistance to our members, other beneficiaries, and medical providers who contacted us regarding access challenges and other transition-related problems. More recently, we have escalated issues related to inaccurate reports of other health insurance (OHI) that prevent claims from processing properly, copay calculations, and claims being improperly processed as non-network.

End of Referral Waiver Extensions

The Defense Health Agency will not extend the TRICARE West Region referral approval waiver, which expired June 30.

* If a beneficiary received a primary care manager (PCM) referral waiver prior to that date, they may continue seeing their specialty care provider without a point-of-service charge through Sept. 30, at which point they will need a referral from their PCM to continue treatment.

* If a beneficiary did not receive a referral waiver, they must follow standard referral practices as of July 1. More information is available at the TriWest website.

MOAA meets regularly with the managed care support contractors – TriWest and Humana Military – as well as new leadership at the Defense Health Agency (DHA) to address the numerous problems the T-5 transition has created for beneficiaries and providers. At MOAA's urging, TRICARE issued policy waivers to facilitate access to care as the contractors worked through systemic problems and continued to build a functional network in the West Region.

What's Next

Congress provides vital oversight on the multibillion-dollar TRICARE contracts, and MOAA has taken this issue to Capitol Hill, assisting lawmakers' offices with their oversight efforts.

Thanks to legislation included in the FY 2019 National Defense Authorization Act (NDAA), the Government Accountability Office (GAO) is required to conduct an evaluation of each TRICARE contract transition. The GAO has already started its T-5 assessment, but the breadth, magnitude, and duration of T-5 problems demand a more detailed analysis than what's required by statute.

MOAA has outlined recommendations for detailed report requirements addressing beneficiary continuity of care, network adequacy, the impact of transition problems on access to care, and DHA's oversight role leading up to the transition. We are urging members of Congress to ensure these requirements are included in the FY 2026 NDAA.

Please watch the MOAA newsletter and MOAA's advocacy news page for updates on MOAA's efforts to secure a comprehensive analysis of the T-5 transition to improve future contractor changeovers.