How the Government Shutdown Affects TRICARE
During the federal government shutdown, those using the Military Health System should expect military medical and private sector provider services through TRICARE to remain available.
According to the TRICARE official site, inpatient services, acute medical needs, and emergency outpatient care will proceed without interruption.
How the Government Shutdown Affects TRICARE
For those who receive care in the private sector, the TRICARE provider network is expected to function as usual. Providers should continue to honor established TRICARE copayments and cost-sharing agreements. TRICARE patients should not face unexpected financial demands at the point of service.
However, a situation could arise where a network provider or pharmacy might request that a patient pay the full cost of care upfront. If this occurs, the recommended first step is to contact the regional TRICARE contractor for assistance. What to know:
- The contractor can often resolve the issue directly with the provider. If an immediate solution is not possible, patients still have the option to receive the necessary care by paying the full amount. In this case, it is vital to save all receipts.
- These documents will be necessary to file a claim for reimbursement once the government resumes normal operations and funding is restored. This process ensures that a temporary billing issue does not become a barrier to receiving timely medical attention.
- Within military hospitals and clinics, many services will continue, but beneficiaries should be aware of potential adjustments. Inpatient care, which includes surgeries, is at press time slated to continue.
- Patients with scheduled procedures should contact their medical facility. Confirm appointments remain unchanged for best results. Emergency departments and urgent care centers in military hospitals continue to operate and provide their essential services to those in need.
Emergency Services, Urgent Care, Dental Care
Outpatient services, which encompass a wide range of care including routine primary care appointments, specialty consultations, and laboratory work, will also continue; however, some patients may experience disruptions due to the federal government shutdown.
Facilities may adjust their operating hours or modify the scope of available services. For those needing acute care on a walk-in basis, call the facility beforehand to verify the current hours for sick call or as-needed appointments.
Pharmacies located within military treatment facilities may remain open to fill prescriptions. Similar to outpatient clinics, their hours of operation could be subject to change. There might also be an impact on the availability of certain medications.
For beneficiaries who use the TRICARE network of civilian providers, the impact of a shutdown may be minimal. Inpatient services and scheduled surgeries will proceed, though it remains a good practice to confirm with the provider. What else should you know going forward?
- Emergency services remain fully accessible, and patients can visit any TRICARE-authorized emergency provider without needing a prior referral.
- Urgent care access is also maintained, with Prime enrollees not requiring a referral to see an authorized urgent care provider. All other outpatient care, including primary and specialty appointments, is expected to continue without disruption.
- Dental care under the TRICARE Dental Program and the TRICARE Retiree Dental Program is expected to also continue uninterrupted. Managed Care Support Contractors may continue to process new enrollments and changes to Primary Care Manager assignments, as well as provider referrals and authorizations.
- While the processing of claims for payment to providers will continue, an extended shutdown could introduce delays into this system. It’s best to anticipate delays.
Nurse Advice Line, Travel Benefits
The Nurse Advice Line should still be available for beneficiaries. In contrast, the processing of TRICARE Prime travel benefits will be suspended. This benefit assists patients who require travel outside their local area for specialized care. While the benefit is paused, patients should continue to obtain the necessary care, carefully saving all travel-related receipts to submit for reimbursement after the shutdown concludes.
Secure patient portals and websites, such as Beneficiary Web Enrollment, MilConnect, TRICARE Online, and the MHS GENESIS patient portal, will continue to operate.
About the author
Editor-in-Chief Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter/editor for Air Force Television News and the Pentagon Channel. His freelance work includes contract work for Motorola, VALoans.com, and Credit Karma. He is co-founder of Dim Art House in Springfield, Illinois, and spends his non-writing time as an abstract painter, independent publisher, and occasional filmmaker.
