Note: The following coverage updates do not apply to TRICARE For Life, US Family Health Plan, TRICARE Overseas, or TRICARE East Region beneficiaries.

TRICARE Prime users in the West Region will have two more months under a waiver allowing them to see specialty care providers without a contractor-approved referral, the Defense Health Agency (DHA) announced April 30. A day earlier, the DHA outlined how West Region beneficiaries who’ve been disenrolled from TRICARE can reestablish their coverage.

Referral Waiver Rules

West Region beneficiaries can bring their referral from a TRICARE-authorized primary care manager (PCM) along with a copy of the approval waiver letter to their TRICARE-authorized specialist. The waiver does not apply to PCMs at some military hospitals and clinics which have resumed regular waiver processing; your provider should tell you whether your clinic is in the group. It also does not apply to:

• Inpatient care
• Applied behavior analysis or Autism Care Demonstration services
• Lab tests
• Services under the Extended Care Health Option (ECHO)

It’s the second extension of the referral waiver as part of the new TRICARE contracts, which took effect in earnest at the start of the year.

[RELATED: MOAA's TRICARE Guide]

Reenrollment Process

West Region beneficiaries who pay for their TRICARE coverage outside of the allotment process (via bank card or bank transfer, credit card, or other setup) had until April 30 to provide payment information and make a payment to TriWest. Those who did not do so were disenrolled as of May 1 and must pay the full cost for all care received this calendar year.

Beneficiaries can seek reinstatement until June 30 by calling TriWest at (888) 874-9378. To be reinstated, beneficiaries must provide payment information and pay for all enrollment fees and premiums. Those who choose not to reenroll will:

• Only receive care at military treatment facilities on a space-available basis.
• Be able to apply for 2026 TRICARE Prime or Select coverage during open season, which starts in November, unless they have a qualifying life event, which opens a 90-day window to enroll in a plan.
• Be unable to reapply for a TRICARE premium-based plan (TRICARE Young Adult, TRICARE Reserve Select, TRICARE Retired Reserve) within 12 months from their disenrollment date.

For more information or to contact TriWest, visit the contractor’s webpage.