Tricare Prime patients won’t have to get a referral to get their COVID-19 vaccination outside the military health system, under a special waiver announced by the Defense Health Agency. This means they won’t have to pay fees to the shot provider if they don’t get a referral beforehand.
With many in the military community searching for avenues to get the vaccine, or anxiously waiting their turn, this will give increasingly more options to about 3.4 million people enrolled in Tricare Prime. Currently the actual vaccine is free because it’s paid for by the federal government. But those who give the shots, such as civilian clinics and pharmacies, are allowed to charge an administration fee for the process involved in getting the shot into the arm.
As an example of possible fees, Medicare pays providers who administer COVID-19 vaccinations $28.39 to administer single-dose vaccines. For vaccines that require two doses, the initial dose payment is $16.94, and $28.39 for the administration of the final dose, according to the Centers for Medicare and Medicaid Services. But even these rates are adjusted by geographic area.
Normally, if Tricare Prime patients don’t get a referral from their primary care physician for health care outside the military system, they will have to pay a point-of-service charge to that outside provider.
The waiver is retroactive to Dec. 13, and will apply for the period of the declaration of the COVID-19 national emergency, according to the announcement.
This doesn’t include active duty service members. They pay nothing for their health care.
The Defense Health Agency “believes the widespread need for COVID-19 vaccines and the fact that supply of these vaccines may be limited is a special circumstance necessitating the waiver of the referral requirement for Tricare Prime enrollees so they may receive a COVID-19 vaccine” at other locations, according to the announcement.
On the other hand, Tricare beneficiaries who prefer to get their vaccination at a military treatment facility are eligible to get it there, even if they don’t get their routine care at an MTF. That doesn’t mean the vaccinations are available, though.
Military treatment facilities are at various stages in opening up eligibility for the COVID-19 vaccination, and in many cases, beneficiaries can get their vaccinations more quickly through their local or state health departments. In most areas, active duty family members don’t fall into the eligibility categories yet because of their age, as the eligibility in many areas is open to those 65 and older, and those with underlying medical conditions, in addition to those in higher-priority categories who are vaccinated first. But as more vaccine becomes available, and eligibility opens up, the waiver for Prime enrollees will provide increasing options.
The federal government has launched the Federal Retail Pharmacy Program for COVID-19 Vaccination, a collaboration between the federal government, states, territories, and 21 national pharmacies and independent pharmacy networks to increase access to the COVID-19 vaccine. The CDC provides a list of these pharmacies here and advises people to check the websites of the individual pharmacies to determine if they have the vaccine available, and if they are eligible for vaccination.
Beneficiaries are also encouraged to check the Facebook pages and websites of their local military treatment facilities to see whether they may be eligible, and to see if their MTF has a supply of vaccine. MTF websites may also have information. Check here to find your local MTF’s website, or search online for the name of the MTF.
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.
