2026 TRICARE Updates: What Therapy Practices Need to Know

2026 has officially begun, bringing new updates across the healthcare industry, particularly within TRICARE. These annual updates are designed to align coverage, costs, and care delivery with federal guidelines and evolving healthcare needs. 

For 2026, TRICARE has introduced meaningful changes related to cost structures, coverage expansion, and care supervision. They directly influence reimbursement, patient access, compliance requirements, and billing workflows. 

Staying informed is essential for therapy providers. Understanding these changes early helps practices adapt smoothly, reduce administrative disruptions, and continue delivering consistent care to TRICARE beneficiaries. 

This blog outlines the key TRICARE updates for 2026, including industry-wide and regional changes, while focusing on how they impact therapy specialties. 

What’s New in TRICARE for 2026?

In 2026, TRICARE introduced several updates affecting plan costs, pharmacy benefits, regional plan administration, and expanded medical coverage. While not all changes directly alter therapy services, they influence overall patient costs, access patterns, and admin conversations within therapy practices. 

Industry-Wide Updates and Benefit Changes

• Increased Plan Costs: Most TRICARE plan costs, including enrollment fees, deductibles, copayments, and premiums, increased modestly for 2026, generally aligning with annual retiree COLA adjustments. 
• Pharmacy Copayment Changes: For most beneficiaries using retail network pharmacies and home delivery services, pharmacy copayments have increased with variations across formulary tiers. 
• Expanded Medical Coverage: TRICARE implemented routine coverage updates for 2026, including formulary adjustments and alignment with updated clinical guidelines. These changes are administrative and clinical refinements, not major benefit expansions, and have minimal direct impact on therapy services. 

Please note that these medical coverage updates do not change eligibility or reimbursement rules for ABA, PT, OT, or speech therapy services. 

Regional Updates

• New TRICARE Prime Competitive Plans Demonstration: Beginning January 1, 2026, eligible beneficiaries in select ZIP codes within metro Atlanta, GA, and Tampa, FL, can enroll in a new TRICARE Prime option managed by CareSource Military & Veterans (CSMV).
• Enrollment Flexibility Update: TRICARE previously used temporary waivers allowing some beneficiaries to remain enrolled after certain relocations. These flexibilities have now ended, and standard Prime access rules apply. 

For detailed TRICARE health plan cost information, beneficiaries should refer directly to the official TRICARE website. 

How 2026 TRICARE Updates Impact Therapy Specialties?

TRICARE updates affect multiple areas of the healthcare system, including therapy services such as ABA, physical therapy, speech therapy, and occupational therapy. While coverage structures remain largely intact, several operational and access-related changes influence how therapy services are delivered and reimbursed.

• Expanded Virtual Care: Telehealth and virtual care remain a permanent part of TRICARE coverage, whenever clinically appropriate and allowed by benefit rules.  
• Provider Network Stability Concerns: Some therapy practices reported unpaid claims and credentialing challenges following the 2025 transition to new regional contractors. This can affect continuity of care as providers exit networks, especially in the West Region under TriWest Healthcare Alliance. Therapists must regularly update their information with regional contractions (Humana Military for East, TriWest for West), to avoid payment delays. 
• Autism Care Demonstration (ACD): ABA remains covered under the Demonstration and has not yet been transitioned into a basic TRICARE benefit. Providers must continue meeting all compliance and documentation requirements to maintain coverage and reimbursement. 

What do These Changes Mean for Therapy Practices?

While the 2026 TRICARE updates do not significantly alter therapy benefit structures, they introduce operational challenges. Changes in costs, regional administration, and referral workflows require therapy practices to focus on accuracy, oversight, and clear communication across clinical and administrative teams. 

Some of the key operational impacts include:

• Increased Billing Complexity: Annual cost adjustments, regional contractor workflows, and ongoing specialty-specific requirements make TRICARE billing complex. 
• Higher Claim Denial Risks: Even minor issues in eligibility verification, referrals, or authorizations can result in delayed or denied claims under TRICARE. 
• Eligibility and Authorization Errors: Inaccurate DEERS information, outdated referrals, or missed authorization renewals for programs like ACD can disrupt care and reimbursement.
• Greater Patient Inquiries About Costs and Coverage: Rising copayments and plan cost changes often lead to increased questions from beneficiaries, placing additional demands on front-desk and billing teams. 

For therapy practices, it’s essential to stay ahead of these operational impacts by implementing proactive systems and consistent verification processes. Additionally, they can improve performance by gaining clear visibility into patient eligibility, authorizations, and claims status.  

How TherapyPM Helps You Stay Compliant with 2026 TRICARE Updates?

Adapting to the 2026 TRICARE updates doesn’t have to feel like walking through fog. TherapyPM equips your practice with the tools to navigate eligibility changes, manage authorizations, and simplify billing workflows. The therapy software reduces your administrative burden and costly errors. 

Here’s how TherapyPM supports your team with these TRICARE changes:

1. Centralized Authorization Management: Track referral and authorization status in real time, receive alerts for upcoming renewals, and store documentation in structured and searchable folders. 
2. Efficient Insurance Billing: Verify TRICARE eligibility and benefits before service delivery, submit claims with clean & compliant data, reduce manual data entry, monitor claim status, and resolve denials faster. 
3. Fewer Eligibility Errors, Faster Patient Service: Catch potential errors earlier, such as incorrect DEERS data or outdated referrals. Verify coverage and confirm authorizations before treatment starts, to keep patients informed and reduce frustration. 
4. Better Patient Communication Around Costs & Coverage: With plan cost changes in TRICARE for 2026, patients are more likely to ask questions about copays, deductibles, and benefits. TherapyPM gives your team clear visibility into benefit details, so you can answer confidently and schedule smoothly.

TherapyPM doesn’t just help you process TRICARE claims. It gives your practice the controls and visibility you need to stay compliant, avoid denials, and manage administrative tasks confidently. 

Conclusion

The 2026 TRICARE updates reinforce a familiar reality for therapy practices. While coverage structures may remain largely stable, the administrative and operational demands continue to evolve. Changes in plan costs, regional administration, and ongoing compliance requirements, particularly for programs like Autism Care Demonstration (ACD), require therapy providers to stay proactive and well-informed. 

For ABA, physical, speech, and occupational therapy practices, success in 2026 depends on accurate eligibility verification, timely authorizations, and clean billing workflows. Staying ahead of these requirements not only helps prevent denials and payment delays. It also ensures uninterrupted care for TRICARE beneficiaries and their families. 

With TherapyPM, navigating TRICARE updates becomes easier. Therapy practices can use these tools to improve visibility, reduce administrative errors, and simplify day-to-day operations. This can help maintain compliance, efficiency, and help patients focus on what matters the most, i.e., delivering high-quality care. 

Want to simplify TRICARE compliance in 2026? 

Join TherapyPM to simplify eligibility, authorizations, and billing in one place. Start your 30-day free trial today!