Editor’s Note: This article was updated in October 2022 and is part of MOAA’s 2022-23 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2022 issue of Military Officer magazine.
TRICARE has made permanent its recent coverage for virtual health visits done via phone, which surged during the COVID-19 pandemic.
At the beginning of the pandemic, TRICARE introduced telehealth coverage expansions to encourage people to stay home, avoid exposure, and reduce transmission of the virus. Telehealth, also known as virtual health or telemedicine, includes appointments that take place via phone, either video or audio.
As of this summer, TRICARE has made permanent coverage for audio-only phone visits.
The pandemic caused an unprecedented increase in the use of telehealth services. In 2019, about 2% of outpatient appointments in the Military Health System were virtual. That number surged during the pandemic, reaching a high in April 2020 when 46% of all MHS outpatient appointments were via telehealth, according to the annual Evaluation of the TRICARE Program.
That leveled off by the end of 2020, when approximately 20% of all outpatient appointments were virtual.
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TRICARE also waived TRICARE Prime and Select copays during the pandemic, but a notice in the Federal Register has announced the telehealth copay waiver will be coming to an end. A date has yet to be announced.
DoD has decided to end the copay waiver given the availability of vaccines and the reduction of stay-at-home orders. While telehealth services remain a covered benefit, TRICARE Prime and Select beneficiaries will have a copay or cost share for telehealth visits once the waiver ends.
TRICARE’s decision to end the telehealth copay waiver does not affect TRICARE for Life (TFL) beneficiaries who are covered by both Medicare and TFL. Medicare’s telehealth policy has been connected to the COVID-19 national emergency, which was renewed in July by the White House; the administration said it would provide a 60-day notice before allowing the national emergency to expire, and Medicare’s existing telehealth coverage will extend at least five months after that expiration.
For now, TFL beneficiaries will continue to have zero cost share for covered telehealth visits. Medicare pays 80%, and TRICARE picks up the remaining 20%.
If Medicare’s COVID-19 telehealth coverage expansions are not made permanent, TRICARE would become the first payer for telehealth services not covered by Medicare, and TRICARE’s deductible and cost shares would apply. MOAA is monitoring Medicare coverage changes related to COVID-19 and will provide updates via MOAA.org and The MOAA Newsletter.
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