Military treatment facilities in the United States have resumed billing civilians for medical care following a three-year pause. This change affects an estimated 137,000 civilians who received treatment at these facilities since June 21, 2023, according to officials from the Defense Health Agency. These individuals include Department of Defense civilian employees and other civilians who sought emergency and trauma care, both domestically and abroad.
The ability for military medical facilities to bill non-beneficiary civilians has always existed under specific legal conditions, typically on a reimbursable basis. However, the costs associated with such medical care have led to financial strain for many. To address this issue, Congress included a provision in the 2023 National Defense Authorization Act, granting the Department of Defense the authority to protect these patients from financial hardship. This law enabled the introduction of a sliding fee scale and a catastrophic fee waiver.
The billing suspension initiated in June 2023 aimed to allow the Department of Defense to develop the new Military Health System Modified Payment and Waiver Program, designed to assist civilians facing financial difficulties. Once a patient receives a bill, they are encouraged to apply for this program if they encounter financial strain. In an official statement, agency representatives highlighted, “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.”
Although officials did not specify a timeline for when the bills will be issued, a final rule published in the Federal Register on February 6 confirmed that the program took effect on March 9, 2026. The total amount of the billing is currently unknown, as individual bills will vary based on the type and duration of treatment received.
For patients with other health insurance, military hospitals or clinics will file medical claims on their behalf, leaving patients responsible for co-pays, coinsurance, deductibles, and any non-covered services. Those without health insurance will receive a direct bill from the military facility where they were treated. Each bill will contain instructions on how to apply for financial assistance through the new program.
The application process for financial relief will be determined by the standards set out in the final rule. This includes a sliding fee scale and catastrophic waiver benefits. Additionally, the program offers flexible installment plans, allowing patients to spread payments over a period of up to 72 months. The final rule employs the Federal Poverty Guidelines to establish eligibility for discounts. Families with an annual income at or below 100% of these guidelines may qualify for a full discount. For example, in 2026, a household of four in the contiguous United States with an annual income of $32,150 would meet this threshold.
For further assistance, patients can visit the Military Health System website to find detailed instructions on applying for financial relief. They can also reach the Defense Health Agency’s Debt Adjudication office for support, available Monday to Friday from 08:00 to 17:00 Central Standard Time at 210-295-3344 or via email at [email protected].
