Nov 20, 2024
|
4
min read
Starting January 1, 2025, a major shift will take place in the TRICARE health system, bringing with it a new contract designed to improve healthcare delivery, choice, and access for beneficiaries. Here’s a breakdown of what healthcare providers need to know to navigate the transition smoothly and ensure their patients continue to get the care they need.
Key Changes to TRICARE Starting in 2025
Provider Network Flexibility: TRICARE is expanding provider options, giving beneficiaries more flexibility in choosing their healthcare providers.
Improved Beneficiary Choice: Beneficiaries will have more options when it comes to selecting plans and providers, making it easier to find the care they need.
Telehealth Enhancements: Expect more opportunities for patients to access care via telehealth, making it easier for them to connect with their providers from the comfort of home.
Important Changes to TRICARE Regions
As part of the 2025 TRICARE contract update:
State Shift from East to West Region:
Six states will move from the East Region to the West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin.
TRICARE beneficiaries overseas are not impacted by these changes.
FAQs: What Providers Need to Know
Q1: What’s Changing?
West Region: TriWest Healthcare Alliance will replace Health Net Federal Services (HNFS).
East Region: Humana Military will remain the contractor, but six states are moving from the East to the West Region starting January 1, 2025.
Q2: As a TRICARE provider, do I need to do anything?
East Region Providers: No action needed.
West Region Providers: If you’re a provider in the West Region or in one of the six states moving to the West, you’ll need to contact TriWest to join their network.
Q3: Do my TRICARE patients need to do anything?
Beneficiaries should ensure their information is up to date in the Defense Enrollment Eligibility Reporting System (DEERS) to avoid missing important updates.
No immediate action is needed from beneficiaries for the rest of 2024. Care delivery and benefits will remain unchanged until January 2025.
Q4: How will beneficiaries and providers receive updates?
Updates will be sent throughout the year by the Defense Health Agency (DHA) and the TRICARE contractors, detailing the transition process and necessary steps.
Sign up for email alerts from TRICARE to stay in the loop on T-5 updates.
Q5: Will my patients be able to stay with their current providers?
Yes, but this depends on whether the provider remains in the network.
Humana Military and TriWest will publish updated provider directories in November 2024. Providers should inform patients of their network status, especially if their provider is transitioning in or out of the network.
Q6: How can I stay in or join the West Region Network?
If you’re currently in the West Region, contact TriWest directly to join their network or stay in it.
Q7: Will this change impact scheduled care for my TRICARE patients?
East and Overseas Region: No impact on scheduled care.
West Region: TriWest will honor existing referrals and authorizations from HNFS, as long as they are valid.
Q8: Will beneficiaries pay more to stay with their current providers?
No change in copays or cost shares due to the T-5 contract.
Out-of-pocket costs will depend on the type of provider (network, non-network/participating, or non-network/non-participating).
Q9: Will beneficiaries need to re-enroll for their benefits?
No. As long as beneficiaries are eligible and currently enrolled, their coverage will continue uninterrupted.
TRICARE Open Season (Nov. 11 – Dec. 10, 2024) is the time for beneficiaries to make any plan changes. Changes will take effect January 1, 2025.
Steps Healthcare Providers Should Take:
Confirm Provider Status: If you’re in the West Region or in a state shifting to the West, get in touch with TriWest about joining their network.
Stay Informed: Sign up for TRICARE email alerts to receive real-time updates about the transition.
Ensure DEERS Accuracy: Encourage your patients to keep their DEERS info current to ensure smooth communication and benefits processing.
Review Updated Provider Directories: TriWest and Humana Military will publish their directories in November 2024, helping you identify which providers remain in network.
The TRICARE 2025 changes aim to make healthcare more accessible, flexible, and efficient for beneficiaries. As a healthcare provider, staying informed, updating your network status, and ensuring your patients are aware of these transitions will help you navigate this shift smoothly. Keep an eye on updates and be ready to adapt to a more streamlined TRICARE system!
For more information
Tricare Wrest "I need to.." guide - click here
Tricare West "2025 Changes Chart Format" - click here
Tricare Website - click here
