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DoD and TRICARE: Department of Defense Guide

A comprehensive guide to the U.S. Department of Defense's role in managing TRICARE, including the DHA, regional contractors, and 2026 benefit structures.

DoD and TRICARE: Department of Defense Guide

*Disclaimer: TRICARE.com is an independent reference site and is not the official TRICARE program or the Department of Defense. For official policy and government information, visit TRICARE.mil or Defense.gov.*

## Quick answer The United States Department of Defense (DoD) is the federal executive department responsible for providing the military forces needed to deter war and protect the security of the U.S. In the context of healthcare, the DoD operates the **Military Health System (MHS)** and the **Defense Health Agency (DHA)**, which manage the TRICARE program for over 9.5 million service members, retirees, and their families.

In detail

The Department of Defense (DoD) is the largest employer in the world and manages one of the most complex healthcare systems globally. While most people associate the DoD with combat operations, it is also the primary insurer and healthcare provider for the military community.

### The Healthcare Hierarchy The DoD manages healthcare through a specific chain of command: * **The Secretary of Defense:** Oversees all military operations and personnel benefits. * **Defense Health Agency (DHA):** A joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force. The DHA manages the TRICARE program. * **The Military Health System (MHS):** The umbrella term for the DoD's multi-billion dollar healthcare network, which includes Military Treatment Facilities (MTFs) and civilian provider networks.

### TRICARE Regional Management As of 2026, the DoD divides the management of TRICARE into two geographic regions within the United States, overseen by private contractors: * **East Region:** Managed by **Humana Military**. * **West Region:** Managed by **TriWest Healthcare Alliance** (which assumed management on January 1, 2025, under the T-5 contract transition).

### 2026 Enrollment Tiers The DoD categorizes beneficiaries into "Groups" which determine out-of-pocket costs: * **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.

### TRICARE Program Oversight The DoD dictates the rules for various plans including: 1. **TRICARE Prime:** A managed care option (HMO-like) mostly at MTFs. 2. **TRICARE Select:** A self-managed, preferred-provider option (PPO-like). 3. **TRICARE For Life:** Wrap-around coverage for those with Medicare Parts A and B. 4. **TRICARE Pharmacy Program:** Managed by **Express Scripts** under DoD contract.

## Who this applies to The military healthcare policies set by the Department of Defense apply to: * **Active Duty Service Members (ADSMs):** Mandatory enrollment in TRICARE Prime; 100% of healthcare costs covered by the DoD. * **Active Duty Family Members (ADFMs):** Options for Prime or Select; costs vary based on Group A or B. * **National Guard and Reserve:** Eligible for TRICARE Reserve Select (TRS) if not on active duty. * **Retirees and their Families:** Eligible for TRICARE Select or Prime (until age 65) and TRICARE For Life (post-65). * **Survivors and Medal of Honor Recipients:** Specifically defined benefit structures managed by the DHA.

Common scenarios

**1. Active Duty Specialist (Group B) in the West Region** An Army Specialist stationed at Fort Irwin (West Region) needs surgery. Because they are Active Duty, the DoD covers 100% of the cost. Under the TriWest contract in 2026, the specialist receives care at a military hospital. Total cost to the soldier: **$0**.

**2. Retired Officer (Group A) on TRICARE Select** A retired Air Force Major living in the East Region (Humana Military) visits a civilian network specialist in 2026. As a Group A retiree, they may face an annual deductible of approximately **$150 per person** and a copayment of roughly **$30–$40 per visit**, depending on the specific 2026 rate adjustments published by the DHA.

**3. Pharmacy Refill via Mail Order** A Navy spouse needs maintenance medication. The DoD pharmacy contract with Express Scripts allows for home delivery. For a 90-day supply of a brand-name formulary drug in 2026, the spouse might pay a **$38 copay**, significantly less than the cost at a local retail pharmacy.

## Related terms * **Defense Health Agency (DHA):** The specific DoD component that manages TRICARE operations. * **DEERS:** The Defense Enrollment Eligibility Reporting System; the DoD database used to verify TRICARE eligibility. * **Military Treatment Facility (MTF):** A hospital or clinic located on a military base and operated by the DoD. * **T-5 Contract:** The fifth generation of TRICARE contracts which reorganized the West Region under TriWest Healthcare Alliance. * **Sponsor:** The active duty or retired service member through whom family members gain health benefits.

## Sources * **TRICARE.mil:** https://www.tricare.mil * **U.S. Department of Defense (Defense.gov):** https://www.defense.gov * **Defense Health Agency:** https://health.mil * **TriWest Healthcare Alliance:** https://www.triwest.com