TRICARE Government Oversight and Management Guide

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## Quick answer The TRICARE program is managed by the **Defense Health Agency (DHA)** under the authority of the **Assistant Secretary of Defense for Health Affairs**. While the government sets the policy, funding, and coverage rules, its daily operations—such as processing claims and managing provider networks—are carried out by private government contractors: Humana Military (East Region), TriWest Healthcare Alliance (West Region), and Express Scripts (Pharmacy).

In detail

The governance of military healthcare is a multi-layered structure designed to provide health benefits to active duty service members, retirees, and their families. As of 2026, the system operates under the "T-5" contract generation, which emphasizes high-quality network management and data integration.

### The Defense Health Agency (DHA) The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force. They are responsible for: * Managing the TRICARE Health Plan. * Overseeing the $50+ billion Unified Budget. * Operating Military Medical Treatment Facilities (MTFs), such as Walter Reed or Brooke Army Medical Center.

### Regional Contractors (The Private Partners) The government does not manage the provider networks directly. Instead, they "buy" healthcare services through regional contracts. * **TRICARE East:** Managed by **Humana Military**. Includes 24 states in the eastern U.S. * **TRICARE West:** Managed by **TriWest Healthcare Alliance** (as of Jan 1, 2025). Includes 26 states in the western U.S. * **TRICARE Overseas:** Managed by **International SOS**.

### Legislative Oversight Because TRICARE is a federal program, its benefits are dictated by the **National Defense Authorization Act (NDAA)** passed annually by Congress. For example, any changes to 2026 enrollment fees or the inclusion of new covered treatments must be authorized by federal law before the DHA can implement them.

### Funding and Beneficiary Categories Government funding and out-of-pocket costs are determined by the beneficiary's status, categorized into two tiers for modern enrollment: * **Group A:** Sponsor’s initial enlistment or appointment was before Jan. 1, 2018. * **Group B:** Sponsor’s initial enlistment or appointment was on or after Jan. 1, 2018.

## Who this applies to * **Active Duty Service Members (ADSMs):** Managed entirely by the government (DHA) with $0 out-of-pocket costs; must use MTFs or have a referral. * **Active Duty Family Members (ADFMs):** Can choose between government-managed (Prime) or contractor-network (Select) care. * **National Guard & Reserve:** Eligible for TRICARE Reserve Select (TRS), a premium-based plan managed by the government but administered by contractors. * **Retirees:** Must pay annual enrollment fees to the government to maintain coverage under Select or Prime.

Common scenarios

**1. The Contractor Transition** An Air Force retiree living in Arizona (West Region) noticed their claims processor changed on January 1, 2025. Because the **government** awarded the T-5 contract to TriWest Healthcare Alliance, the retiree had to ensure their automatic payments were updated from the old contractor (HNFS) to the new one to avoid a lapse in their 2026 coverage.

**2. The Legislative Change** In a recent NDAA, Congress mandated that the government cover certain 3D mammography screenings. Because the **Defense Health Agency** updated the TRICARE Policy Manual to reflect this federal law, a Navy spouse in the East Region was able to receive the screening with no copay at a Humana Military network provider.

**3. Direct vs. Purchased Care** An Army Private at Fort Liberty (Direct Care) sees a government doctor at Womack Army Medical Center for $0. However, when the MTF is full, the **government** issues a referral for the Private to see a civilian specialist (Purchased Care), with the bill being processed by Humana Military using government funds.

## Related terms * **Defense Health Agency (DHA):** The federal agency that manages TRICARE and military hospitals. * **Military Medical Treatment Facility (MTF):** A hospital or clinic owned and operated by the government on a military base. * **T-5 Contract:** The fifth generation of TRICARE contracts which established the current regional boundaries and providers. * **National Defense Authorization Act (NDAA):** The annual federal law that sets TRICARE's budget and coverage rules. * **Purchased Care:** Healthcare services provided by civilian doctors but paid for by the government.

## Sources * Defense Health Agency: [https://health.mil/About-MHS/OATSD/Defense-Health-Agency](https://health.mil/About-MHS/OATSD/Defense-Health-Agency) * TRICARE Official Site: [https://www.tricare.mil](https://www.tricare.mil) * Humana Military (East): [https://www.humanamilitary.com/](https://www.humanamilitary.com/) * TriWest Healthcare Alliance (West): [https://www.triwest.com/](https://www.triwest.com/)