Note: TRICARE’s regional contract changeover and associated waivers will not impact the benefits of TRICARE For Life, TRICARE Overseas, or US Family Health Plan users.

TRICARE Prime enrollees in the West Region can receive covered specialty care without a contractor-approved referral, the Defense Health Agency (DHA) announced Jan. 25 – a decision retroactive to the Jan. 1 changeover to new contractor TriWest.

The move will allow beneficiaries to avoid problems with TriWest’s referrals portal. While MOAA is appreciative of all DHA efforts to smooth this transition process, there are details beneficiaries should keep in mind as they navigate the waiver procedure, which will remain in place through March 31:

• Patients still must obtain a referral from their primary care manager (PCM) before receiving TRICARE-covered specialty care. The waiver only allows beneficiaries to skip the referral portal, meaning it will not assist those facing long waits for PCM care as a new patient under the new network, or those still seeking a new PCM.
  
  
• The waiver does not apply to all types of specialty care, to include inpatient care, care connected to applied behavior analysis or TRICARE’s Autism Care Demonstration, or services through the Extended Health Care Option (ECHO) program, which offers help to beneficiaries with special needs.
  
  
• The waiver does not apply to lab-developed tests.

[RELATED: New Contractor, New Challenges for Some Beneficiaries]

How the Waiver Works

In cases where the waiver applies, beneficiaries should do the following, according to DHA:

• Ask their PCM for a copy of the referral. Even if a civilian provider can send the referral electronically, DHA recommends requesting a physical copy.
• Ask their PCM to recommend a TRICARE-authorized specialty care provider (see note below), or find a provider using the TriWest provider directory.
• Take the referral to the specialty care provider, along with a copy of the waiver letter (PDF download).

Until April 1, TRICARE Prime users in the West Region can see non-network providers and pay standard TRICARE Prime copayments. Note: Non-network providers must be TRICARE-authorized. This means they’re licensed by a state, accredited by national organization, or meet other standards of the medical community and certified to provide benefits under TRICARE. Make sure to ask non-network providers if they’re TRICARE-authorized before getting care.  

Starting April 1, if the provider is still a non-network provider and isn’t named on your pre-authorization, you’ll need to pay point-of-service fees.

[RELATED: MOAA's TRICARE Guide]

Referrals approved by previous TRICARE contractors (Humana Military or Health Net Federal Services) before Jan. 1, 2025, will be honored by West Region providers through their expiration or June 30, 2025, whichever comes first.

Have You Updated Your Method of Payment?

Retirees in the West Region using TRICARE Prime or Select, along will beneficiaries enrolled in TRICARE Young Adult, TRICARE Reserve Select, or TRICARE Retired Reserve, have until Feb. 28 to update their credit/debit/electronic funds transfer payment information with TriWest. Those who do not have a payment method on file as of Feb. 28 could be disenrolled back to Jan. 1.

The deadline has been extended multiple times since the changeover. TRICARE For Life beneficiaries and those who pay for TRICARE benefits via military allotment do not have to update their information to maintain coverage.

Learn how to make the update online at this link, or contact TriWest at 1 (888) 874-9378 to update your information over the phone.

MOAA’s Role

MOAA remains in contact with TriWest and DHA officials as this transition continues. We hope to ensure all beneficiaries retain access to care throughout the process, and that any disruptions are overcome by further waivers, outreach efforts, and other programs designed to secure service-earned benefits continue with limited interruption.

If your family has faced problems stemming from the Jan. 1 contractor changeover, please contact MOAA at legis@moaa.org. Only by identifying the areas of concern can MOAA help both DHA and its contractors become aware of issues, point them toward potential solutions, and encourage proper oversight.