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Ensuring Access to Healthcare for Military Families
On January 1, 2025, TRICARE - the essential healthcare benefit serving millions of service members, retirees, and their families - entered a new cycle of contracts for managing the military's healthcare system.
The TRICARE East contracting company, Humana Military, transitioned from Wisconsin Physicians Services (WPS) Health Solutions to a new fiscal intermediary/claims processor, Palmetto Government Business Administrators (PGBA). The TRICARE West region contract transitioned from Health Net Federal Services (HNFS) to TriWest Healthcare Alliance.
Both TRICARE contractors reassured healthcare providers and beneficiaries the transition would be seamless and there would be no services interruptions.
However, the transition has been marked by serious complications with many beneficiaries reporting barriers to receiving appropriate medical services and extra financial consts.
This survey was developed as a grassroots effort to determine effects to the beneficiaries' access to healthcare services. It is not intended to be used for research purposes, but to serve as an indicator for potential larger issues within the military healthcare system.
Survey Infographic - One Page
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Military Family Comments - Highlights
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Conclusion
Since the launch of the new TRICARE contracts on January 1, 2025, families across the country have experienced a catastrophic disruption in care. Sixty-one percent of survey respondents in TRICARE East and seventy-five percent in TRICARE West reported a disruption in medical services.
Obtaining prior authorizations and referrals was a barrier encountered by the majority of survey respondents in both TRICARE regions. This remains a prevalent barrier despite the Defense Health Agency issuing a waiver to allow specialty care referrals without a prior authorization for TRICARE prime beneficiaries. A theme in the military family comments was that providers would not honor the waiver due to lack of trust that TRICARE would later pay for the services provided.
The source of these failures lies not only with the regional contractors - Humana Military (East) and TriWest Healthcare Alliance (West) - but with the Defense Health Agency (DHA), which bears full responsibility for contract oversight and system accountability.
The DHA's implementation and oversight of the transition to new managed care organizations has been fraught with problems that have had severe adverse effects on TRICARE beneficiaries as well as providers.
In order to minimize harm to TRICARE beneficiaries, we urge Congress and the Department of Defense to quickly remedy these issues and take steps to ensure the highest quality of healthcare for our men and women serving in uniform as well as their families. Failure to do so will result in decreased readiness, resilience, and retention for our armed forces.
Contact your senator or representative, share this survey and write an email describing your family's experience receiving medical services since January 1st.
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Request Congress and the Department of Defense to quickly remove the barriers preventing beneficiaries from accessing medical services such as delayed provider reimbursements and prior authorizations for procedures and specialty care.
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Request Congress and the Department of Defense to create policies to protect beneficiaries from unexpected fees incurred due to the mismanagement of the TRICARE contract transition.
We extend our deepest gratitude to the military families who courageously shared their stories. Your authentic voice is a catalyst for change - a force so compelling that it can not be ignored.
Healthcare Provider Surveys
On January 1, 2025, the TRICARE East contracting company, Humana Military, transitioned from Wisconsin Physicians Services (WPS) Health Solutions to new fiscal intermediary/claims processor, Palmetto Government Business Administrators (PGBA).
TRICARE providers were required to complete new PGBA enrollment paperwork, and Humana Military stated that all provider data would seamlessly migrate to the new system on January 1st.
However, the transition has been marked by serious complications leaving many providers unable to submit claims or receive payments. This survey seeks to determine payment barriers experienced by providers and the impact to the TRICARE provider network.
One-page Infographic
TRICARE East Healthcare Provider - Full Report
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On January 1, 2025, the TRICARE West region contract transitioned from Health Net Federal Services (HNFS) to TriWest Healthcare Alliance.
In 2024, TriWest began notifying HNFS-contracted providers of the transition and projected that all of the new contracts would be executed by January 2025. They stated that TRICARE providers transitioning from the East Region would transition seamlessly on January 1st.
However, the transition has been marked by serious complications leaving many providers unable to submit claims, receive contracts, or receive payments. This survey seeks to determine payment barriers experienced by providers and the impact to the TRICARE provider network.
One-page Infographic
TRICARE West Healthcare Provider - Full Report