TRICARE Payments May Be Delayed Due to Government Shutdown
The government shutdown is disrupting parts of the TRICARE system in spite of previous assurances that this would not happen. While hospitals and clinics remain open, there is concern about potential delays in payments to the network of off-base doctors, specialists, and hospitals that provide essential care for those in the TRICARE program.
Any prolonged failure by Congress to pass a federal budget or a stopgap measure could strain this network and cause long-term consequences for healthcare access.
Some TRICARE Payments May Be Delayed Due to Government Shutdown
The Department of Defense has issued statements that designate private-sector care under TRICARE an “excepted” activity, which should exempt it from a shutdown.
However, the TRICARE website, TRICARE.mil, warns that while patients can continue to attend appointments and fill prescriptions, the system “may not be able to process or pay medical claims received on or after October 1, 2025, until funding is restored.”
Air Force Times notes, “Since Oct. 1, providers are being told that claims payments have stopped” because of the government shutdown. Some providers are leaving TRICARE over such payment issues, further complicating the issue. The Defense Health Agency (DHA) states it is working with TRICARE’s regional contractors concerning these potential delays.
Military family advocates voice strong concerns that this uncertainty could compel some providers to stop accepting TRICARE patients. This is not a hypothetical risk. Even before the shutdown, some providers reported payment delays from the end of the fiscal year.
Some worry that if a substantial number of providers leave the TRICARE network, military families could face reduced healthcare options, longer wait times for appointments, and greater difficulty finding specialized care. This could have effects long after the government restores funding.
Some TRICARE Payments Continue
TriWest Healthcare Alliance, which manages the TRICARE West Region, states that it “continues to pay claims.” However, the company also acknowledges that the lapse in government funding may cause delays “in medical claims payments until funding is restored.”
TriWest officials say their goal is to continue meeting the contractual standard of paying 98% of claims within 30 days. They concede, however, that they may not return to that performance level until the shutdown ends and government reimbursements resume.
Humana Military, the East Region contractor, uses its own funds to pay some claims on a limited basis. Humana says this solution has limits. The government will not pay certain claims during the shutdown, particularly those that require direct federal review and approval, because the necessary personnel and funding are unavailable. Humana has reportedly notified some providers that it has put payments on hold due to the uncertainty.
What TRICARE Says
Beneficiaries should experience no disruption when seeking emergency or urgent care. Likewise, existing outpatient appointments, lab work, referrals, and pre-authorizations should not be affected. The TRICARE Pharmacy Program, including retail network pharmacies and home delivery, remains operational during the shutdown at press time.
Other services are on less stable ground. TRICARE lists the Prime Travel Benefit, which reimburses for certain travel expenses, as “not available.”
Patients may be required to cover these costs out-of-pocket and file for reimbursement after the shutdown ends. Reduced staffing levels may delay or pause government administrative services, such as appeals, line of duty determinations, and grievance processing.
Basically, military families should, according to official sources, expect their access to care to continue, but with the understanding that the system supporting this care is under stress.
Frequently Asked Questions About the Government Shutdown and TRICARE
What is the main problem for TRICARE if the government shuts down?
The primary issue is that the 2025 government shutdown may delay or halt payments to civilian medical providers who care for TRICARE beneficiaries. While military medical facilities will remain open, the network of private-sector doctors and hospitals that service members and their families rely on may not receive timely reimbursement for their services.
Can I still go to my doctor’s appointments?
At press time, official guidance indicates that beneficiaries should continue to keep scheduled appointments and seek both urgent and emergency care as needed. Access to care is not expected to be immediately affected.
Why am I hearing different things from the DoD and the official TRICARE website?
The Department of Defense says:
“Our military hospitals and clinics will remain open during the government lapse in appropriations. Hours of operation and available services may be affected. We encourage you to contact your local military hospital or clinic with questions about hours of operation, scheduled appointments, or other services. ” It adds, “If you get care from civilian TRICARE network or non-network providers, you should feel little or no immediate effect.”
However, the official TRICARE.mil website provides more detail, warning that while you can still receive care, the government may not be able to process or pay the claims for that care until funding is restored. The DoD’s message focuses on the continuity of care, while TRICARE’s message addresses the practical financial mechanisms that support it.
How does this shutdown affect my civilian doctor?
Civilian providers who accept TRICARE operate as businesses and rely on timely payments to cover their own costs, such as staff salaries and medical supplies. If TRICARE payments are delayed for a long time, it creates a significant financial strain. This could lead some doctors to consider no longer accepting TRICARE patients, which would reduce healthcare options for military families in the long run.
What are the TRICARE contractors, Humana Military and TriWest, doing about payments?
The two regional contractors have different strategies. Humana Military (East Region) is using its own corporate funds to cover some claims for a limited time to create a temporary buffer. TriWest Healthcare Alliance (West Region) has stated it will continue paying claims but warns that there may be delays until the government restores funding.
Which TRICARE services are expected to continue normally?
According to TRICARE.mil, you should see no disruption in emergency care, urgent care, outpatient appointments, lab work, referrals, and pre-authorizations. The TRICARE Pharmacy Program, including retail pharmacies and home delivery, is also expected to remain fully operational. However, the shutdown is an ongoing issue and conditions may change in the future.
Are there any TRICARE benefits that will be unavailable during a shutdown?
The TRICARE Prime Travel Benefit reimburses beneficiaries for certain travel costs related to specialty care. This is, at press time, listed as “not available.”
Save receipts and file for reimbursement after the shutdown ends, but be aware that you may have to pay for the expenses out-of-pocket for now. Administrative services, like processing appeals or grievances, may also be delayed.
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.
