Tricare beneficiaries in certain ZIP codes will switch to — or stay in — a different Tricare region than the rest of their state come the new year, according to the Defense Health Agency.
Six states will switch from Tricare’s East Region to the West Region starting Jan. 1, 2025, as announced earlier this year. However, after conducting a recent evaluation, Tricare officials announced Tuesday that they have now carved out select ZIP codes in four states where more than 2,000 beneficiaries will be in a different region from the rest of their state come Jan. 1. This includes limited ZIP codes in two states — Missouri and Indiana — that aren’t among the regional shift.
The ZIP codes are being carved out because they border another state with a nearby military hospital or clinic and are part of that military treatment facility’s prime service area, which is defined as a 40-mile geographical region around a military hospital or clinic where Tricare Prime is available, officials said.
Tricare officials conducted a “significant evaluation” of the potential for carve-outs over several months, a Defense Health Agency spokesperson told Military Times.
“Health care will not be affected by these carve-outs. They instead ensure the Prime networks will continue to function as [they] have been before the upcoming changes in regions,” the spokesperson said.
Officials have been conducting targeted outreach to beneficiaries affected by the ZIP code carve-outs, according to a source familiar with the efforts.
The ZIP code carve-outs come two years after the new Tricare contracts were awarded and it was announced that all beneficiaries in Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin would move to the West Region. At the time, officials said switching the 1.5 million beneficiaries from the East Region to the West Region would provide a more equitable balance of beneficiaries.
Areas impacted by the new ZIP code carve-outs include:
- Arkansas: Most of the state is switching to the West Region, but those living in certain ZIP codes in eight counties will stay in the East Region, including certain areas in Clay, Craighead, Crittenden, Cross, Greene, Mississippi, Poinsett and St. Francis counties.
- Indiana: Those living in certain ZIP codes in Benton, Fountain, Lake, Vermillion or Warren counties will switch to the West Region, unlike the rest of their state, which stays in the East Region.
- Missouri: Those living in certain ZIP codes in Butler, Dunklin, New Madrid and Pemiscot counties will be in the East Region, unlike the rest of their state, which stays in the West Region.
- Wisconsin: Most of the state is switching to the West Region, but those living in certain ZIP codes in Florence County will stay in the East Region.
As the Dec. 10 deadline for Tricare open season changes approaches, beneficiaries should review whether these tweaks could impact their health care plan decisions. To determine your Tricare region, visit Tricare’s website, scroll down the navigation bar on the right side and enter your ZIP code in the tool labeled, “What’s my Tricare region in 2025?”
Further, some beneficiaries in new carve-out areas are now in the West Region, where a new contractor, TriWest Healthcare Alliance, takes over effective Jan. 1. All West Region beneficiaries should contact TriWest before Jan. 1 to ensure their contact information is up to date. Beneficiaries also need to transfer their payment information if they pay enrollment fees or premiums by credit card or bank transfer.
For active duty family members who don’t pay enrollment fees, these carve-outs will be transparent, officials said.
If beneficiaries don’t provide TriWest with payment information before Jan. 1, they may be involuntarily disenrolled from Tricare and potentially lose their health coverage. If they pay by military allotment, they don’t need to take action.
Beneficiaries staying in the East Region don’t need to take action, as the contractor, Humana Military, remains the same and will keep the payment information on file.
