Officials from the Defense Health Agency have announced that military hospitals and clinics will resume billing civilians for medical care after a three-year hiatus. This change, which took effect on March 9, 2023, could impact approximately 137,000 civilians who received treatment at military facilities since June 21, 2023.
The civilians affected include Department of Defense employees and others who sought emergency or trauma care at military treatment facilities, both domestically and abroad. Under federal law, military medical facilities can provide care to non-beneficiaries under specific circumstances, typically on a reimbursable basis. However, the high costs associated with this care have left many civilians in financial distress.
To address this issue, Congress included a provision in the 2023 National Defense Authorization Act, granting the Department of Defense authority to implement measures aimed at protecting patients from financial hardship. This legislation authorized the creation of a sliding fee scale and a catastrophic fee waiver program. Following the introduction of these provisions, billing was paused in order for the Department of Defense to establish the Military Health System Modified Payment and Waiver Program.
Once civilians receive their medical bills, those facing financial difficulties are encouraged to apply for relief through this program. According to agency officials, “We encourage all non-beneficiary civilians who received treatment in an MTF or clinic after June 21, 2023 to take full advantage of this program to see how much financial relief they may qualify for when they receive their bill.”
While specific timelines for the billing process have not been disclosed, the final rule implementing the new program was published in the Federal Register on February 6, 2023. Each bill will vary depending on the type and duration of treatment provided.
The Military Health System has stated that if a patient has additional health insurance, the military clinic or hospital will file claims on their behalf. Patients will still be responsible for any copays, coinsurance, deductibles, nominal fees, and services not covered by insurance. Those without health insurance will receive a direct bill from the military facility.
Each bill will include detailed instructions on how to apply for financial relief through the modified payment program. Applications will be assessed according to the standards outlined in the final rule, which includes a sliding fee scale and catastrophic waiver benefits.
Additionally, the final rule guarantees flexible payment options, allowing patients to spread their payments over a period of up to 72 months. The program determines eligibility for sliding fee discounts and catastrophic waivers based on the Federal Poverty Guidelines. For instance, in the United States, a household of four earning an annual income of $32,150 in 2026 is classified at 100% of the federal poverty level.
Those seeking financial assistance can find instructions for applying on the Military Health System website. For further inquiries, patients may contact the Defense Health Agency’s Debt Adjudication office during business hours at 210-295-3344 or via email at [email protected].
