As the federal government shutdown continues, some Tricare medical providers are being told their claims for services for military families may not be paid until government funding is restored, according to contractors, advocates and the Tricare.mil website.
It’s not clear why those claims are delayed or why the money isn’t available now to pay claims for that care, as the Defense Department’s shutdown guidance specifically exempts private-sector care under Tricare from the shutdown’s effects.
“You can’t tell providers to keep seeing people free of charge,” said Kristi Cabiao, CEO and founder of Mission Alpha Advocacy, an organization that works to improve quality of life for military families with special needs. “I thought this was an entitlement. I’m really concerned for our families.”
According to shutdown guidance issued by DOD, “private sector care under Tricare” is excepted from the shutdown, and is specifically identified as one of the missions and functions that may continue to be carried out in the absence of available appropriations.
The shutdown information page on Tricare.mil reiterates that guidance, saying Tricare patients “may continue to get care or attend currently scheduled appointments with your civilian providers. Your usual out-of-pocket costs will apply.”
However, a key issue for medical providers is payment for their services. The Tricare page goes on to state that “Tricare may not be able to process or pay medical claims for services received on or after October 1, 2025, until funding is restored. The Defense Health Agency is also working with our Tricare contractors to also communicate with healthcare providers on potential delays in payment.
“We understand this may cause concern and inconvenience, and we sincerely regret the disruption. We remain committed to resuming full operation as quickly as possible once appropriations are enacted.”
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Cabiao said some providers in the East and West Tricare regions have told her that claims payments stopped Sept. 22 — about 10 days before the government shutdown began Oct. 1 — “due to the normal slowdown at the end of the fiscal year.”
Since Oct. 1, providers are being told that claims payments have stopped because of the government shutdown, Cabiao said. Some providers have told her they’re dropping Tricare, including some who are still owed money from the troubled TriWest Healthcare Alliance contract transition this year.
“I don’t know how providers are going to recover from this,” Cabiao said.
Information wasn’t immediately available from the Defense Health Agency about the lack of money available for the payment of claims.
TriWest officials told Military Times that it “continues to pay claims,” but due to the lapse in government funding, “there may be delays in medical claims payments until funding is restored.”
TriWest’s objective during the shutdown is to pay within the contractual standard, which is 98% within 30 days, TriWest officials said.
“We remain committed to returning to our current performance as quickly as possible once the shutdown has ended” and the government resumes reimbursement.
Providers may continue to provide services to beneficiaries and submit claims, TriWest officials added.
Humana Military officials told Military Times they are working with the Defense Health Agency to minimize the impact of the government shutdown as much as possible on providers and beneficiaries.
“Certain claims are reviewed and approved directly by the government, and those, generally, will not be paid during the shutdown, as there aren’t personnel or funding to do so,” Humana officials said. “Other claims are reviewed and approved solely by Humana Military. For those types of claims, Humana Military is continuing to pay providers with funds from the company for a limited period of time.”
Cabiao said some providers have received emails from Humana, stating, “Payments are on hold right now for everyone due to the government shutdown … Due to the current uncertainty regarding government appropriations to Humana Military during the federal government shutdown, there may be delays in claims payments should the situation persist. Please be assured that all available options are being evaluated to minimize disruption to provider payments and services.”
Humana officials confirmed that the wording is consistent with messages Humana Military has sent to certain providers.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families.” She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
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