House of Representatives & TRICARE: Legislation & Costs

*Disclaimer: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense or the official TRICARE program. For official policy and the latest updates, visit TRICARE.mil.*

## Quick answer The U.S. House of Representatives determines the funding, benefits, and eligibility rules for TRICARE through the annual National Defense Authorization Act (NDAA). While the Department of Defense administers the health plan, the House—specifically the Committee on Armed Services—is responsible for legislating changes to pharmacy copays, enrollment fees, and the expansion of coverage for military families.

## In detail The House of Representatives serves as the primary legislative body where most changes to the TRICARE program begin. Because the "power of the purse" resides in Congress, any adjustment to how TRICARE is funded or structured must pass through the House.

### The Role of the House Armed Services Committee (HASC) The **HASC Military Personnel Subcommittee** is the most influential body regarding TRICARE. They oversee: * **The NDAA:** This annual bill sets the budget for the Defense Health Agency (DHA). * **Benefit Expansion:** Legislation for things like TRICARE Young Adult coverage or mental health access typically originates here. * **Cost Shares:** The House debates and sets the caps on how much beneficiaries pay for services.

### Impact on 2026 TRICARE Costs As of June 2026, the House-approved budget for the current fiscal year maintains the tiered structure for "Group A" and "Group B" beneficiaries. While specific 2026 rates are determined by administrative formulas, the House has the power to freeze or cap these increases via the NDAA.

### Key Legislative Focus Areas (2025-2026) * **Mental Health Parity:** The House has recently prioritized reducing copays for mental health visits to ensure they are no higher than primary care visits. * **The T-5 Transition:** House Oversight committees monitor the performance of **TriWest Healthcare Alliance** (West Region) and **Humana Military** (East Region) to ensure the transition to the new contract maintains provider network stability. * **Pharmacy Copays:** The House regulates the tiered pricing for medications filled through **Express Scripts**, often intervening if proposed price hikes on generic drugs are too steep.

## Who this applies to * **Active Duty Service Members (ADSMs):** The House determines their "zero-out-of-pocket" status and supplemental program funding. * **Retirees and Families:** These groups are most impacted by House-led changes to enrollment fees (e.g., TRICARE Select) and pharmacy copays. * **National Guard and Reserve:** The House is currently debating the "TRICARE for All" legislative concepts that would expand TRICARE Reserve Select eligibility. * **Young Adult Dependents:** The House is responsible for any future laws that might align TRICARE Young Adult costs with the Affordable Care Act (allowing children to stay on plans until age 26 without separate premiums).

## Common scenarios 1. **Pharmacy Price Hikes:** A retiree using Express Scripts sees a generic drug price jump. This cost change was likely authorized (or not blocked) by the House in the previous year's NDAA to offset military spending. 2. **Expanded Chiropractic Care:** A Member of the House introduces a bill to include chiropractic care for military spouses. If it passes the House and Senate and is signed into law, the DHA must update TRICARE policy to cover it. 3. **Regional Network Changes:** Following the transition to TriWest in the West Region, a House Representative may hold a hearing if constituents report that too many doctors are leaving the TRICARE network.

## Related terms * **National Defense Authorization Act (NDAA):** The annual federal law that specifies the budget and expenditures of the U.S. Department of Defense, including TRICARE. * **Defense Health Agency (DHA):** The joint integrated combat support agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force; they implement the laws passed by the House. * **House Armed Services Committee (HASC):** The specific group of Representatives that drafts the laws governing military pay and healthcare. * **Entitlement Program:** A federal program that guarantees certain benefits to a particular group; TRICARE is a statutory entitlement for those who serve.

## Sources * **House Armed Services Committee:** [https://armedservices.house.gov](https://armedservices.house.gov) * **TRICARE.mil (Legislative Updates):** [https://www.tricare.mil/About/Changes](https://www.tricare.mil/About/Changes) * **Congressional Budget Office (CBO) - Military Healthcare:** [https://www.cbo.gov/topics/defense/military-personnel-and-health-care](https://www.cbo.gov/topics/defense/military-personnel-and-health-care) * **Defense Health Agency (DHA):** [https://health.mil](https://health.mil)