Editor’s Note: This article is part of MOAA’s 2025-26 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 2025 issue of Military Officer magazine.  

TRICARE contract transitions are complex and the move to T-5 – the next generation TRICARE-managed care support contracts – was no exception.

More than 1.5 million TRICARE users in six states – Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin — moved from the TRICARE East Region to the West Region, while all West Region beneficiaries changed contractors, from HealthNet Federal Services to TriWest. Humana Military retained the redefined East Region but changed claims processors. 

MOAA expressed concerns about the T-5 transition and highlighted factors key to beneficiary continuity of care well before the changeover took effect Jan. 1, 2025 – and we will continue to seek solutions and accountability for the many problems beneficiaries have faced. Our advocacy on beneficiary problems related to the transition resulted in two report requirements attached to the House version of the FY 2026 National Defense Authorization Act (NDAA).

The House Armed Services Committee (HASC) report accompanying the NDAA directs the Pentagon to evaluate the T-5 transition, examining the TRICARE contract acquisition process, implementation, health care delivery, and lessons learned. 

“The committee notes with concern the Department of Defense Military Health System’s (MHS) administration of the T–5 TRICARE contract,” the report states. “The ensuing contract implementation in both the TRICARE East and TRICARE West regions interrupted quality of care and negatively impacted servicemember and family readiness.”

The report also notes the importance of timely claims processing and directs a study on the status of health insurance claim processing in the TRICARE West and East regions for calendar year 2025, which must include:

• A detailed analysis of the primary causes of TRICARE claim processing and payment delays.
• An inventory of all claims that were delayed and the number of beneficiaries affected by care disruptions, delayed authorizations, or inability to access services due to these delays.
• An inventory of all health providers who left the TRICARE network.
• Recommendations to prevent claim processing and payment delays in the future.

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Since January, MOAA has provided direct assistance to our members, other beneficiaries, and medical providers who contacted us regarding access challenges and other transition-related problems. More recently, we have escalated issues related to inaccurate reports of other health insurance (OHI) that prevent claims from processing properly, copay calculations, and claims being improperly processed as non-network or point of service.  

TRICARE is defined in statute, but many beneficiary problems lack a legislative solution. The patient experience is impacted by every element of the military health system (MHS) – policy, regulation, contracts, implementation, and performance. That’s why MOAA’s work on the TRICARE and the MHS requires us to engage at every level.

We’ve met regularly with the managed care support contractors – TriWest and Humana Military – as well as leadership at the Defense Health Agency (DHA) to address the numerous problems the T-5 transition has created for beneficiaries and providers.  

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At MOAA’s urging, TRICARE issued policy waivers to facilitate access to care as the contractors worked through systemic problems and continued to build a functional network in the West Region. 

While TRICARE problems can’t always be addressed with a legislative fix, Congress does have a vital oversight role on the multibillion-dollar TRICARE contracts. MOAA has taken T-5 transition issues to Capitol Hill and assisted lawmakers’ offices with their oversight efforts. 

Thanks to legislation included in the FY 2019 National Defense Authorization Act (NDAA), the Government Accountability Office (GAO) is required to conduct an evaluation of each TRICARE contract transition. The GAO has already started its T-5 assessment and MOAA has provided feedback for the report.  

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As MOAA fielded beneficiary problems, provider complaints, and questions from congressional offices related to T-5, one thing became clear: beneficiaries need better options for reporting and resolving TRICARE problems.

We will continue working on our goal of improved options for problem reporting, including a digital system that would allow beneficiaries to report and get assistance with access to care problems.

Military families should not have to contact their members of Congress to seek resolution to TRICARE problems or health care access challenges.