Military Health Plans Get a 2026 Tune-Up: Yawn-Worthy Update Alert
Published Date: 10/28/2025
Notice
Summary
If you’re on TRICARE, get ready for some updates in 2026! From January 1, new plan options and changes kick in, and you can make your choices during Open Season from November 10 to December 9, 2025. These updates might affect your healthcare, dental, and vision coverage, so don’t miss the chance to review and switch plans if you want to save money or get better benefits.
Analyzed Economic Effects
16 provisions identified: 12 benefits, 2 costs, 2 mixed.
Hormone Therapy No Longer Covered for Minors
For beneficiaries age 18 or younger, TRICARE no longer covers puberty blockers or sex-hormone treatments to treat gender dysphoria, pursuant to Section 708 of the FY2025 NDAA and Executive Order 14187.
Unlimited Urgent Care for Prime
If you're enrolled in TRICARE Prime, urgent care visits are unlimited without referrals for CY 2026. You may use TRICARE-authorized urgent care centers, convenience clinics, or TRICARE network providers without a referral; non-network urgent care may incur Point-of-Service deductibles and cost-shares.
No Cost-Sharing for TRICARE Contraceptives
TRICARE eliminated cost-sharing for all TRICARE-covered contraceptives under the TRICARE Pharmacy Benefit pursuant to Section 707 of the FY2025 NDAA, so beneficiaries pay no pharmacy cost-share for covered contraceptives.
TRICARE Covers Weight-Loss Drugs for Obesity
TRICARE will cover weight-loss drugs (for example, certain GLP-1s) to treat obesity for TRICARE Prime and Select beneficiaries when prescribed by a TRICARE network provider, deemed medically necessary, and integrated into a comprehensive treatment plan; prior-authorization forms were revised to limit inappropriate use.
Expanded Survivor TRS and TYA Eligibility
For Selected Reserve members enrolled in TRICARE Reserve Select on or after October 1, 2025, eligible surviving family members may purchase or continue TRS coverage for up to three years from the member's death (if the death occurred on or after October 1, 2025). Surviving young adult dependents may purchase TYA coverage with survivor (retiree) cost-shares up to three years after the member's death or until age 26, whichever occurs first.
Prime Enrollment Fee Waiver Limited to Group A
The TRICARE Prime enrollment fee waiver is available only to Group A Medicare-eligible retirees and their family members enrolled in Medicare Part B (Group A = sponsors who originally entered uniformed service before January 1, 2018). All Group B Medicare-eligible beneficiaries must pay the TRICARE Prime enrollment fee.
Drive-Time Waiver Removed Inside 100 Miles
If you are enrolled in TRICARE Prime and move to a residence within 100 miles of a military medical treatment facility (MTF) but at least 30 minutes away by car, you no longer need to request a waiver to remain enrolled in Prime. If you move farther than 100 miles from the MTF, you must make an affirmative enrollment decision or risk losing access to your TRICARE benefit.
Expanded Coverage for Multiple Procedures
TRICARE expanded coverage for several procedures and services for CY2026, including laparoscopic or transcervical radiofrequency ablation for symptomatic uterine fibroids (with beneficiary cost-sharing), cryoablation for lung malignancies, TENS devices for acute post-operative pain (covered for 30 days after surgery or up to 90 days with preauthorization), coronary artery calcium scoring when medically necessary per guidelines, basivertebral nerve ablation for chronic vertebrogenic lower back pain, and expanded coverage criteria for certain prophylactic risk-reducing surgeries.
Faster Cochlear Implants for Eligible Children
TRICARE eliminated the requirement that certain children undergo a three-to-six-month hearing aid trial before receiving cochlear implants when they have post-meningitis hearing loss, evidence of cochlear ossification, or bilateral severe-to-profound sensorineural hearing loss, expediting implant access.
Expanded Clinical Trials Routine-Care Coverage
Effective August 27, 2025, TRICARE covers routine care provided as part of NIH-sponsored clinical trials that study severely debilitating or life-threatening conditions, rare diseases, and infectious diseases tied to a declared Public Health Emergency or National Emergency.
Provisional Coverage for Alzheimer Monoclonals
TRICARE extended provisional coverage beginning October 23, 2024, for monoclonal antibody drugs (for example, lecanemab and donanemab) to treat mild cognitive impairment or mild dementia stages of Alzheimer's disease for a five-year period when used according to FDA labeling and when care is preauthorized; PET scans may be used to confirm target biology for coverage.
New Competitive Plans Demonstration Option
From January 1, 2026 through December 31, 2028, TRICARE-eligible beneficiaries living in certain ZIP Codes in metro Atlanta, GA and metro Tampa, FL can voluntarily enroll in the Competitive Plans Demonstration (CPD) and select TRICARE Prime with CareSource Military & Veterans; the annual TRICARE enrollment fee will be waived for the first year they enroll as CPD participants.
Pharmacy Copayment Increases Jan 1, 2026
TRICARE pharmacy copayments will increase effective January 1, 2026; the notice lists 2026 copayment amounts for retail and mail-order supplies (examples shown for 2026 include $16, $48, and $85 for certain 30-day retail supplies, and $14, $44, and $85 for certain mail-order supplies). Active duty Service members continue to have a $0 copay for covered drugs.
Open Season: Enrollment Window
If you're a TRICARE beneficiary, you can enroll in or change TRICARE Prime or TRICARE Select during Open Season from November 10 through December 9, 2025. FEDVIP dental and vision open season runs November 10 through December 8, 2025, and any changes you make will take effect January 1, 2026.
Mail-Order Prescription Refill Confirmation
If you use the TRICARE mail order pharmacy, you must confirm you want a prescription refill via a notification (email or text) and by logging into your account before the drug is dispensed; declining or not responding removes the prescription from automatic refill but you will still receive reminders until it expires.
HPV Testing Covered on New Schedule
TRICARE covers primary human papillomavirus (HPV) testing alone for beneficiaries ages 30-65 every five years; for ages 30-65 co-testing every five years and pap tests every three years are also covered; beneficiaries ages 21-29 are covered for pap tests every three years. FDA-approved self-collection tests are also covered.
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