NEW TRICARE POLICY LETS YOU STAY WITH YOUR PRIMARY CARE MANAGER IF YOU MOVE—NO WAIVER NEEDED
Moving to a new home? Or have a commute that is more than 30 minutes from your primary care physician? As a part of the new contracts, in light of the TriWest Healthcare Alliance takeover, TRICARE is making it easier for you to keep your TRICARE Prime coverage. While a patient’s distance from military hospitals or clinics used to require waivers if they had a Prime plan, there is no longer a restriction, and most families can continue to see their PCM.
TRICARE Prime Travel Restrictions Lifted
TRICARE Prime patients no longer need a waiver to keep their coverage and receive care at a military hospital or clinic that doesn’t fit the traditional distance requirements.
Under the new TRICARE contracts, beneficiaries can keep their current primary care manager (PCM) or can choose to change. Patients who move to a location outside that access standard for primary care can choose to receive their care at a DoD facility, or they can keep their primary care manager without having to secure a waiver.
To help everyone transition, TRICARE is providing letters to those affected with the details and steps to switch if they choose that option.
"This new approach will help prevent unnecessary coverage gaps and ensure families keep access to their PCMs," said DHA management and program analyst Shane Pham.
Why TRICARE Prime Is Changing
This change comes about under the new management contracts that TRICARE continues to navigate.
The DoD is working to get more military families into military hospitals and clinics as private healthcare facilities continue to gain ground in the market.
While many are pushing for more choice and options involving the private healthcare sector, the VA still needs to maintain enough patients to remain a viable option for military families.
According to a DoD memo in 2023, the goal is to increase the patients going to military healthcare facilities to 3.3 million by 2027, which would be a 7% increase.
“The last thing that a family or that service member needs is to be worried about whether their family is getting adequate or high-quality care,” said Acting Assistant Secretary of Defense for Health Affairs Dr. Stephen Ferrara.
Increasing Patient Satisfaction
TRICARE has been paying attention to what patients feel with these moves, as the data collected from satisfaction surveys have shown that many are willing to keep their primary care doctors, even if they have to drive over 30 minutes to do so, but have no desire to switch physicians.
Therefore, the TRICARE Prime change will allow beneficiaries who live over 30 minutes from their principal care management to continue their coverage.
Adult patients who are on the Prime coverage will be contacted by a TRICARE regional contract and offered options to continue their healthcare plan. According to the Defense Health Agency, beneficiaries who meet the criteria will receive a letter notifying them that their homes are outside of the coverage range.
If they don't respond to the letter, they will remain with their current primary care managers at their military treatment facility.
Actions TRICARE Prime Beneficiaries Need to Take
If a TRICARE Prime beneficiary moves more than 30 minutes from their PCM, their TRICARE regional contract will contact all adult patients in the houshold via phone, email, mail, or text, explaining options for continuing health coverage.
For those with a TRICARE Prime plan, you’ll have 90 days to decide what you want to do. While you aren’t required to move on from Prime, there is still an option to choose coverage under TRICARE Select or the U.S. Family Health Program, provided it’s available near you.
Failure to do so for patients who have moved over 100 miles from their TRICARE Prime Service Area will result in losing coverage. Furthermore, if you go to a military hospital or clinic, you can only receive care if there’s space.
It’s also important to make sure that your personal info in the Defense Enrollment Eligibility Reporting System (DEERS) is up to date and accurate for the DoD.
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