TRICARE dependent coverage changed in 2025, with additional updates anticipated in 2026. For military spouses, caregivers, and families, now is a crucial time to take action. If you don’t update your benefits, your family could face service interruptions, higher costs, or unexpected coverage gaps next year.

In 2025, TRICARE regions and contractors underwent changes. Referral waivers were discontinued, and premiums for young adults increased. In 2026, potential Prime program pilots and eligibility changes may further impact dependent coverage. Here’s what’s changed and what to do now.

What Changed in 2025

Region and Contractor Reassignments

• On January 1, 2025, TRICARE’s new managed care contracts (called T-5) took effect across the continental U.S. The administrative functions: enrollment, network maintenance, and claims processing moved to new regional contractors.
• Humana Military retained the East Region. TriWest Healthcare Alliance replaced Health Net Federal Services (HNFS) as the West Region contractor.
• Six states—Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin—were reassigned from East to West. Those dependents are now under TriWest’s jurisdiction.
• TriWest will accept unexpired referrals and authorizations issued by the previous contractor prior to January 1, 2025. These will remain valid until their expiration or September 30, 2025, whichever is earlier. This applies to both general referrals and those under the Autism Care Demonstration (ACD).

Referral Waiver Expiration and New Rules

• The Defense Health Agency extended the referral approval waiver for TRICARE Prime dependents in the West Region through June 30, 2025. Under that waiver, specialty care referrals did not require prior approval by TriWest.
• Starting July 1, 2025, standard referral and authorization procedures resume. TriWest will require referrals and approvals in accordance with standard rules for outpatient services, equipment orders, and other services.
• If a provider is non-network and is not named on a referral, point-of-service fees will apply beginning October 1, 2025. That means if you continue to see a specialist who was in the network but is no longer, and your referral is not updated, you may incur extra costs. For example, families could face an additional $50 per visit for a general consultation or up to $200 for specialty care services in point-of-service fees.

Cost Changes and Young Adult Premiums

• TRICARE released its 2025 Costs & Fees sheet. TRICARE Young Adult (TYA) premiums for 2025 are: $727/month for TYA Prime and $337/month for TYA Select.
• These increases are significant, and many military families are calling for reform. Advocacy groups note that TYA costs have increased significantly over the past decade.
• Legislation proposed in 2025—the “Health Care Fairness for Military Families Act”—would allow eligible dependents to remain on TRICARE until age 26 without separate TYA premiums. The bill has not passed yet.
• TRICARE Open Season 2025 is scheduled to take place from November 10 to December 9. During that time, beneficiaries can change enrollment plans or make other updates for coverage that begins in 2026. The FEDVIP dental/vision window runs from November 10 through December 8.
• Families in transition states were required to update their method of payment (direct debit, credit/debit card) with TriWest by December 31, 2024, to ensure uninterrupted billing continuity.
• In 2025, many families in the realigned states faced confusion, delays in claims, and questions about ongoing care with the new contractors. Some issues have been resolved, but it’s still essential to remain vigilant.

What to Expect in 2026

TRICARE Prime Pilot Programs

In 2026, TRICARE will pilot a new Prime model in Atlanta, Georgia, and Tampa, Florida, under CareSource Military & Veterans. The pilot aims to test expanded access and simplified care for dependents and retirees in those metro areas.

In the pilot:

• Referrals may not be required for in-network care

• Enrollment fees waived in Year 1

• Enrollment limited to those metro zones

• Out-of-network access will be restricted

If successful, this pilot could influence broader changes to the Prime program in later years.

Possible Expansion of Dependent Age

If the proposed legislation passes, dependents could stay on TRICARE until age 26 without needing to purchase TYA. That change would relieve many families facing high premiums and narrow transitions. Watch for congressional votes or committee movement in late 2025 or early 2026.

Continued Network and Provider Transitions

Providers must renegotiate or reapply for their participation under the new TRICARE contracts. Some may not rejoin or may change terms, forcing families to find new providers—especially in specialties such as behavioral health and therapy.

The first full year under the new structure will likely reveal emergent issues in referrals, provider directories, and claim routing, particularly in states that have transitioned.

What Spouses Should Do Now

• Confirm your region and contractor by using TRICARE’s region lookup tool. That determines who processes your claims and authorizations.
• Update your DEERS record immediately. Verify address, marital status, dependent child status, and student status. Errors here lead to denied claims or lost eligibility.
• Review active referrals and authorizations. Replace any that expire after September 30, 2025, particularly if your provider is shifting networks.
• Contact your specialist or therapy provider to confirm they are in the new network. If they are not, request a new referral to an in-network provider before appointments.
• Mark Open Season dates: November 10–December 9 for TRICARE; November 10–December 8 for FEDVIP. Use that time to compare plan options (Prime vs. Select) for 2026.

Monitor advocacy and legislation updates. If age-26 coverage becomes law, it could alter your planning significantly.

What It All Means for Military Families

The 2025 TRICARE dependent reforms are among the system’s most significant shifts, involving changes to contractors, resets of referral policies, increased costs, and new coverage boundaries.

In 2026, changes will continue. New Prime pilots, possible age-26 coverage, and ongoing network shifts make it crucial for families to stay informed about their options.

To stay protected, take action now: confirm your contractor, update your DEERS record, verify all referrals, and prepare for Open Season. Proactive steps keep your family covered.

Stay vigilant, plan now, and your family will be ready for the next round of TRICARE changes.

Suggested reads:

• Military Spouses & the Government Shutdown 2025: What You Need to Know Right Now
• The PCS Parenting Playbook: Keeping Kids Grounded While Everything Changes
• Military Spouse Career Accelerator Becomes Permanent In 2026: Higher Stipends, Global Eligibility