Military hospitals and clinics have resumed billing civilians for medical care provided over the past three years. An estimated 137,000 civilians are likely to receive invoices for treatment received at military treatment facilities (MTFs) since June 21, 2023, according to officials from the Defense Health Agency. This group includes Department of Defense civilian employees and other individuals who received emergency and trauma care, both domestically and internationally.
Military medical facilities are authorized by law to offer care to non-beneficiary individuals in specific circumstances, typically on a reimbursable basis. However, the high costs associated with medical procedures have caused financial strain for many civilians. In response, Congress included a provision in the 2023 National Defense Authorization Act that enables the Department of Defense (DOD) to protect these patients from significant financial distress. This provision allows for a sliding fee scale and catastrophic fee waivers.
Implementation of the New Billing Program
The billing process was temporarily halted in June 2023 to allow the DOD to create the new Military Health System Modified Payment and Waiver Program. This program aims to aid civilians facing financial difficulties when they receive medical bills. DOD officials have urged all non-beneficiary civilians who received treatment at an MTF or clinic after June 21, 2023, to utilize this program to assess their eligibility for financial relief.
While a specific timeline for when civilians can expect to receive bills has not been disclosed, a final rule published in the Federal Register on February 6, 2024, indicates the program became effective on March 9, 2024. The total amount of billing remains unspecified, as individual bills will vary based on the type and duration of treatment.
According to the Military Health System, if patients have other health insurance, the military facilities will file claims on their behalf. However, patients will still be responsible for any copays, coinsurance, deductibles, nominal fees, and non-covered services. For those without insurance, bills will be directly issued from the military treatment facilities.
Financial Relief Options for Patients
Each bill will include instructions on how to apply for financial relief through the new program. Applications will be evaluated according to the standards outlined in the final rule, which incorporates a sliding fee scale and catastrophic waiver benefits. The new rule also guarantees flexible payment plans, allowing patients to spread payments over a period of up to 72 months.
The initial process for determining discount eligibility will use the Federal Poverty Guidelines. Individuals whose annual household income is at or below 100% of the federal poverty level may qualify for a full discount. For example, in 2026, a household of four in the continental United States would be at 100% of the federal poverty level with an annual income of $32,150.
For additional information on applying for financial relief, patients can visit the Military Health System’s website or contact the Defense Health Agency’s Debt Adjudication office. Assistance is available Monday through Friday, from 08:00 to 17:00 Central Standard Time, at 210-295-3344 or via email at [email protected].
