TRICARE Prime beneficiaries in the West Region who are receiving specialty care through a referral waiver process will need new referrals to continue that care as of Oct. 1.

The end of the waiver process is the latest milestone in the transfer of the West Region to TriWest Healthcare Alliance, which took over the contract Jan. 1 as part of the new T-5 agreement. The transition was not without its challenges; some of the millions of users who switched contractors (or regions) reported a range of access problems to MOAA and other outlets.

[FROM TRICARE.MIL: West Region Waiver Deadline Details]

A MOAA-supported passage in the House version of the FY 2026 National Defense Authorization Act (NDAA) would require an evaluation of the T-5 transition process, with special focus on the impact the changeover had (and continues to have) on patient care.

While this report would provide actionable information to help protect earned benefits during future contract transitions, beneficiaries in the West Region using the existing waiver process have more immediate steps to take, or they could lose access to specialist care.

(Note: Waiver rules apply to West Region TRICARE Prime beneficiaries only. They do not apply to those under TRICARE Select or TRICARE For Life, to East Region beneficiaries, or to overseas beneficiaries.)

Maintaining Access to Care

• If you are in the West Region and your care referral was issued before Jan. 1, 2025, or was issued after Jan. 1 via the referral approval waiver process, you must have a new referral in order to receive specialist care after Sept. 30. Contact your primary care manager to secure a referral, and allow time for TriWest to process it.
  
  
• If you are receiving care from a non-network specialist, you have until Oct. 1 to change to an in-network specialist or you may face point-of-service fees. You can find an in-network specialist using the West Region Provider Directory.
  
  
• If you do not obtain a new referral, you may face out-of-pocket costs when accessing care from a specialist.

[RELATED: MOAA's TRICARE Guide]

Contact TriWest at (888) 874-9378 with questions, or speak with a beneficiary counseling and assistance coordinator at your military treatment facility.