Editor’s Note: This article is part of MOAA’s 2022-23 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2022 issue of Military Officer magazine.

Improving access to mental health care has been one of MOAA’s top priorities for Congress. In addition to highlighting access challenges related to surging demand and provider shortages, MOAA has focused on reducing excessive TRICARE mental health copays to prevent military families from making painful choices surrounding mental health care.

A military caregiver outlined just such a choice: She and her children — including an 11-day-old infant — moved to Walter Reed National Military Medical Center to help care for her husband, injured by enemy forces in Afghanistan, and they stayed for nearly a year.

The spouse, identified by just her first name, explained how mental health copays have impacted her family.

“[Our children] need therapy to deal with living with the effects of war,” Jacqueline said at the 2019 Elizabeth Dole Foundation Impact Forum attended by MOAA and other advocacy groups. “We had to cut our son’s therapy in half because TRICARE doubled our copay. So, he’s not getting the amount of mental health care, and our daughter can’t get anything beyond what she’s just getting at the (traumatic brain injury) clinic because we just can’t pay for it.”

The price hike, Jacqueline said, “devastated us.”

Securing an Earned Benefit

Uniformed services families, retirees and their families, and survivors deserve a high-quality, comprehensive health care benefit, yet TRICARE beneficiaries pay far more for mental health care than those covered by commercial plans.

The Stop Copay Overpay Act, H.R. 4824, would reduce TRICARE copays for mental health visits to address the financial barrier to accessing mental health care faced by military retirees and many active duty families.

These copays more than doubled from 2017 to 2018 and now stand at $28 to $38 per visit for most active-duty families on TRICARE Select and $33 to $50 per visit for most retirees and their families — significantly higher than commercial plans. The average mental health copay for Federal Employee Health Benefits (FEHB) Program plans, for example, is $20 per visit.

DoD has devoted significant resources to reducing the stigma associated with seeking mental health care, but these advances are undermined by cost-prohibitive copays — particularly with repeated visits typical of most mental health treatment plans.

Reducing beneficiary copays does not impact reimbursement to mental health providers — it shifts more of the cost back to DoD.

The Stop Copay Overpay Act has widespread support in concept, but lawmakers and staff have expressed concerns that other TRICARE fees will be increased to off set the mental health copay reduction — a move they know their constituents oppose based on feedback they’ve received following past TRICARE fee increases. MOAA expressly opposes any plan that funds a mental health copay reduction by increasing other TRICARE fees.

We greatly appreciate the efforts of MOAA members who took this issue to Capitol Hill during our Advocacy in Action event this spring, and we were gratified to learn MOAA’s messaging has resonated on the Hill.

We will continue to seek solutions for excessive mental health copays in Congress.