TRICARE recipients will once again have to pay telehealth copays

For the nearly 10 million people using TRICARE as their healthcare insurance provider, telehealth appointments have been free of copays, adding a layer of finan...

For the nearly 10 million people using TRICARE as their healthcare insurance provider, telehealth appointments have been free of copays, adding a layer of financial relief during a worldwide pandemic. However, that is now about to change as the United States rethinks the pandemic’s national emergency status.

The Defense Health Agency says it will, once again, start charging copays for telehealth visits with medical professionals. The change marks the first time in more than two years that TRICARE recipients will have to pay upfront for remote care. There is one caveat, however. Telephone appointments will not incur copayments, only video calls.

The change does not effect TRICARE for Life recipients.

DHA has not announced when the new rule will take place, however the logistics of the policy are all sewn up. DHA spokesman Peter Graves confirmed to Federal News Network that the policy will not go into effect until the providers are informed of the decision. There is currently no timeline for that process.

“The Defense Department implemented temporary coverage of telephonic office visits effective May 12, 2020, in order to provide beneficiaries the option to obtain some medical services safely from home, reducing their exposure to COVID-19 and to minimize potential spread of the illness,” the June Federal Register notice on the issue states. “With the approval or emergency use authorization of several vaccines by the U.S. Food and Drug Administration, the widespread availability of such vaccines throughout the United States, and the elimination of stay-at-home orders by most states and localities, this provision is no longer necessary.”

DHA estimates that by sunsetting the telehealth copayment waiver it can recoup about $4.8 million in costs a month.

The agency estimates to loose nearly $150 million by not collecting telehealth copays over the past two years.

As far as telephonic appointments go, DHA says the new benefit will cost about $20 million through 2024.

“DoD received positive public comments regarding telephonic office visits including multiple requests for the agency to consider it as a permanent benefit,” the Federal Register notice stated. “After thoughtful consideration of these facts, and through this final rule revising the regulatory exclusion prohibiting reimbursement of telephonic (audio-only) office visits, the DoD will revise the exclusion of audio-only telephonic services and add medically necessary telephonic office visits as a covered telehealth service under the TRICARE Basic Benefit.”

Those comments came from the likes of the American College of Physicians and the American Medical Association.

Groups advocating for service member health said they had some concerns about bringing back the copay.

“The Military Officers Association of America (MOAA) appreciates the temporary TRICARE flexibilities to address the impact of COVID-19 and understands these policies must be revisited,” Karen Ruedisueli, MOAA’s director of government relations for health affairs wrote in a June blog post. “However, we remain concerned about mental health copays and fear the expiration of the telehealth cost sharing waiver will present a barrier to access to those receiving mental health care via telehealth.”

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