New Rules for TRICARE Beneficiaries Making Telehealth Visits

New Rules for TRICARE Beneficiaries Making Telehealth Visits
An Air Force surgeon conducts a virtual health appointment via synchronous video on April 7, 2020. (Photo by Marcy Sanchez/Defense Department)

Telephone-only telehealth appointments will become a permanent benefit under TRICARE next month at the same time a waiver removing copays for all telehealth visits will end.

 

DoD issued a Final Rule addressing TRICARE telehealth expansions on June 1, terminating the cost-sharing waiver and installing the permanent benefit as of July 1. The waiver came in May 2020 in response to the COVID-19 pandemic, part of efforts by federal, state, and local governments to encourage individuals to stay home, avoid exposure, and to reduce possible transmission of the virus.

 

DoD will end the waiver given the availability of vaccines and the reduction of stay-at-home orders. Telehealth services remain a covered benefit, but TRICARE beneficiaries will have a copay or cost share for telehealth visits on or after July 1. You can find cost shares for your specific TRICARE plan and sponsor status using this online tool.

 

The rule change does not affect TRICARE for Life beneficiaries, who will continue to have zero cost share for telehealth visits (Medicare pays 80%, TRICARE picks up the remaining 20%). Medicare's telehealth policy remains connected to the COVID-19 national emergency, which was renewed in April by the White House; the administration said it would provide a 60-day notice before allowing it to expire, and Medicare's existing telehealth coverage will extend at least five months after that expiration. 

 

MOAA will continue to monitor Medicare coverage changes related to COVID-19 and provide any updates via MOAA.org and The MOAA Newsletter

 

[RELATED: MOAA’s TRICARE Toolkit]

 

The Final Rule also makes permanent TRICARE coverage for telephone-only provider visits. Audio-only telehealth visits allow beneficiaries to consult with providers who typically don’t offer telehealth services and expand access to beneficiaries who don’t have access to technology needed for video telehealth visits.

 

As part of its COVID-19 response, DoD also expanded the number of providers available to offer telehealth services by allowing reimbursement for interstate care – that flexibility was not addressed by the Final Rule and remains in place for the time being. MOAA has advocated for telehealth licensure flexibility, and we look forward to seeing the results of a DoD feasibility study requested by the House Armed Services Committee in the FY 2022 National Defense Authorization Act.

 

MOAA appreciates the temporary TRICARE flexibilities to address the impact of COVID-19 and understands these policies must be revisited. However, we remain concerned about mental health copays and fear the expiration of the telehealth cost sharing waiver will present a barrier to access to those receiving mental health care via telehealth.

 

We will continue efforts to reduce copays for both in-person and virtual mental health care, which was part of MOAA’s 2022 Advocacy in Action campaign; please join us by contacting your elected officials and asking them to ensure military families don’t encounter a financial barrier to accessing this care.

 

Have More Questions About Your Health Care Benefit?

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About the Author

Karen Ruedisueli
Karen Ruedisueli

Ruedisueli is MOAA’s Director of Government Relations for Health Affairs and also serves as co-chair of The Military Coalition’s (TMC) Health Care Committee. She spent six years with the National Military Family Association, advocating for families of the uniformed services with a focus on health care and military caregivers.