Tricare Patients Would See Lower Mental Health Care Costs Under Bill Introduced in Congress

Out-of-pocket costs for mental health care appointments for patients in the military health care system would be capped under a bill introduced in Congress on Wednesday.

Under the Stop Copay Overpay Act, Tricare users' out-of-pocket fees for outpatient behavioral and mental health visits would not be allowed to cost more than those for primary care visits. The limitation could cut patients' costs by an average of 48%, according to a news release from the office of Rep. Chrissy Houlahan, D-Pa., one of the bill's sponsors.

"As a veteran, I've seen too many brave men and women struggle to access the mental health care they need and deserve. It's not right," Houlahan, a retired Air Force captain, said in a statement. "Mental health care is health care, and creating cost parity between primary care visits and behavioral and mental health visits would be one giant leap forward in ending the stigma to seek treatment."

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Houlahan and fellow Pennsylvania Rep. Guy Reschenthaler, a Republican, previously introduced the bill in 2021, but it went nowhere. This year, they are being joined in introducing the legislation by Pennsylvania Sen. Bob Casey, a Democrat, possibly giving the measure a boost of bicameral momentum.

In 2018, Tricare copays across the board increased as the health insurance for service members, their families and military retirees retooled its plans.

For example, in 2017, a retiree on Tricare Prime faced a copay of $12 for a behavioral or mental health appointment, according to a 2022 letter from The Military Coalition, an umbrella group for 35 military and veterans organizations. Today, an outpatient visit for specialty care, under which mental health falls, costs retirees on Tricare Prime $37.

To curb those rising costs, the bill introduced Wednesday would bar Tricare from charging copays for outpatient mental and behavioral health visits that are higher than copays for primary care appointments.

Primary care visits cost $25 this year for retirees on Tricare Prime, up to $27 for in-network providers for military family members on Tricare Select, and up to $36 for in-network providers for retirees on Tricare Select. Service members and their families on Tricare Prime have no copays for primary or specialty care.

The bill would also require the Pentagon to report on whether limiting copays for mental health care could result in increasing copays for other services and provide recommendations on how to avoid those increases.

"We can never fully repay our service members and their families for their sacrifice, but we can, and we must, ensure that they get the health care they deserve," Casey, who is running for reelection in a key swing state against a Republican opponent who is an Army veteran, said in a statement Wednesday. "Military service members paid the price to defend our nation; now, we must make sure that they can take care of their health and well-being."

A watered-down variation of the bill has already been included in this year's House-passed version of the annual defense policy bill, known as the National Defense Authorization Act, or NDAA.

The language included in the NDAA would not require co-pays to be capped, but rather would order the Pentagon to report to Congress on Tricare costs for behavioral and mental health. The report would have to include information on "efforts of the secretary of defense to ensure that such cost sharing is affordable for such beneficiaries," as well as recommendations on how to "minimize the burden of such cost sharing," according to the bill text.

Similar language is so far not included in the Senate's version of this year's NDAA, which has advanced out of the Senate Armed Services Committee but has yet to be voted on by the upper chamber. The House and Senate will have to reconcile their respective versions of the NDAA before it can become law.

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