TRICARE 2025-2026: T-5 Contract Guide & Costs | TRICARE.com

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## Quick answer The year 2025 marked the most significant structural shift to TRICARE in nearly a decade, headlined by the transition to the **T-5 regional contracts**. On January 1, 2025, TriWest Healthcare Alliance officially took over as the West Region contractor, while Humana Military maintained the East Region with expanded responsibilities. This transition changed how millions of beneficiaries access specialty care, manage referrals, and interact with the provider network.

In detail

The 2025 "T-5" contract implementation was designed to improve provider network stability and enhance the patient experience. While TRICARE benefit logic (what is covered) remained largely the same, the administration of those benefits shifted significantly.

### 1. The Regional Shift As of January 1, 2025, the TRICARE map remains split into two regions, but the management changed: * **TRICARE East:** Managed by **Humana Military**. * **TRICARE West:** Managed by **TriWest Healthcare Alliance** (replacing Health Net Federal Services). * **Six State Shift:** To balance beneficiary populations, six states (Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin) were moved or solidified within specific regional boundaries to ensure TriWest and Humana managed roughly equal "lives."

### 2. 2025-2026 Costs and Tiers TRICARE costs are determined by the beneficiary's "Group." * **Group A:** Sponsor enlisted before Jan. 1, 2018. * **Group B:** Sponsor enlisted on or after Jan. 1, 2018.

**2026 Annual Enrollment Fees (TRICARE Prime):** * **Group A Retirees:** Approximately $391.92 for individuals / $783.84 for families (2026 rates). * **Group B Retirees:** Approximately $522.00 for individuals / $1,044.00 for families (2026 rates). * *Active Duty Service Members (ADSMs) and Active Duty Family Members (ADFMs) pay $0 enrollment fees.*

**2026 TRICARE Select Deductibles (In-Network):** * **Group A ADFMs:** $150 individual / $300 family. * **Group B ADFMs:** $200 individual / $400 family.

### 3. Pharmacy and Specialty Care * **Pharmacy Manager:** Express Scripts continues to manage the TRICARE Pharmacy Home Delivery and retail network. * **Referrals:** Under the T-5 contract, the transition period required beneficiaries in the West Region to ensure their existing referrals were properly migrated to TriWest’s system to avoid "Point of Service" charges.

## Who this applies to * **Active Duty Families:** Affected by the change in regional contractors and potential shifts in local provider networks. * **Retirees (Group A & B):** Affected by annual increases in enrollment fees and catastrophic caps, which typically adjust every January 1st. * **TRICARE Reserve Select (TRS) Members:** Affected by new monthly premium rates (TRS premiums usually adjust annually based on the cost of the program). * **West Region Beneficiaries:** Specifically impacted by the move from HNFS to TriWest, requiring new login credentials for contractor portals and new contact points for claims.

Common scenarios

### Scenario 1: The West Region Retiree John is a retired veteran in California (West Region). On January 1, 2025, his primary contact for authorization of his physical therapy shifted from Health Net to **TriWest**. Because he is Group A, his 2026 enrollment fee is roughly $392, which he pays via an allotment from his retirement pay.

### Scenario 2: The Group B Active Duty Family Sarah is an active duty spouse who entered the military in 2019. She uses TRICARE Select in the East Region. In 2026, she pays a $34 copay for an in-network primary care visit once her $200 individual deductible is met. Her contractor remains Humana Military.

### Scenario 3: Specialized Pharmacy Needs A beneficiary using specialty medication must use **Express Scripts** for home delivery. In 2026, a 90-day supply of a brand-name formulary drug via mail order costs $44, regardless of which region the beneficiary lives in.

## Related terms * **T-5 Contract:** The fifth generation of TRICARE managed care contracts that began full implementation in 2025. * **TriWest Healthcare Alliance:** The current contractor for the TRICARE West Region as of Jan 1, 2025. * **Catastrophic Cap:** The maximum out-of-pocket amount a family pays for covered services each calendar year. * **Open Season:** The annual period (typically Nov-Dec) when beneficiaries can change their enrollment for the following year. * **Point of Service (POS) Option:** An additional cost incurred when Prime beneficiaries see a provider without a referral.

## Sources * **TRICARE.mil:** [The T-5 Strategy](https://www.tricare.mil/t5) * **Defense Health Agency:** [Upcoming Contractor Changes](https://health.mil) * **TriWest Healthcare Alliance:** [TRICARE West Beneficiary Portal](https://www.triwest.com) * **Humana Military:** [TRICARE East Region Information](https://www.humanamilitary.com)