Despite shifts in beneficiary access – TRICARE eligibility and coverage remains stable

[Terri, Carrie, “The US Military Health System: Promoting Readiness And Providing Health Care,” Health Affairs vol 38, no. 8: Military Health Systems, August 2019, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00239, accessed June 19, 2023, GDS-LL]

Within the US, TRICARE is administered through contracts with two third-party administrators, referred to by the DoD as managed care support contractors.7 The contracts are multiyear competitive contracts that cover the management of enrollment processes, establishment or maintenance of provider networks, finding health care providers and making referrals, customer service functions, medical management for some beneficiary populations, and claims processing. Requirements for these contracts have changed over time, particularly with respect to the amount of medical management and risk sharing expected. Through the current contractors (Humana Military and HealthNet Federal Services), the civilian resources available to the MHS in fiscal year 2018 included approximately 604,000 individual providers (of primary, behavioral health, and specialty care), over 3,600 acute care hospitals, 833 behavioral health facilities, and over 58,000 retail pharmacies.7,8,17

Nature, Volume, And Cost Of Care

Approximately 9.5 million people were eligible for DoD health care in FY 2018.8 This number has been relatively stable over the past several years, although there have been slight shifts in the size of the population by beneficiary group. Since the end of the Cold War, the number of active duty personnel has decreased by half. Consequently, active duty personnel make up only 14.5 percent (1.38 million people) of the TRICARE Prime and Select populations; their family members make up another 17.7 percent (1.68 million people). Military retirees and their dependents make up almost 60 percent of the covered population.8

MHS beneficiaries have access to a broad range of health care benefits, including the full spectrum of preventive and primary care, emergency or acute services, and specialty care services. The MHS covers inpatient, outpatient ambulatory, surgical, and rehabilitative care. In FY 2017 there were more than 1 million inpatient admissions and over 106 million outpatient visits across the direct and purchased care systems (exhibit 3).