U.S. Naval Hospital Yokosuka serves patients at the home of the U.S. 7th Fleet southwest of Tokyo. (Alex Wilson/Stars and Stripes)
Tens of thousands of civilian employees and contractors may soon begin receiving medical bills delayed for nearly three years as the Pentagon resumes billing for care provided at military hospitals and clinics.
The Defense Health Agency began sending invoices Monday for deferred copays and other charges tied to treatment at military medical facilities, according to the Military Health System.
Billing was halted in June 2023 while the Pentagon developed financial protections for patients not covered by Tricare.
Since then, more than 137,000 civilian patients have received treatment at military facilities, MHS spokesman Peter Graves said in an email Tuesday. These include DOD employees and non-DOD civilians treated in emergency or trauma cases.
The bills could total more than $146 million in copays, deductibles and coinsurance already processed by private insurers, Graves said.
A new rule that took effect Monday establishes a sliding scale for what DOD civilians must pay. The rule, published Feb. 6 in the Federal Register, created MHS’s Modified Payment and Waiver Program.
“Every one of these patients is eligible to apply to have their balance significantly reduced or eliminated based on their income,” Graves said.
Medical bills will include information explaining the program and how patients can apply for financial assistance.
Individual bills may vary widely depending on the type of care received, Graves said, ranging from a small emergency room copay to significant charges for extended trauma care.
Bills for insured patients reflect costs already processed by private insurers. Invoices for uninsured patients, which were never formally generated during the billing pause, are expected to begin going out in the coming weeks, Graves said.
DHA will not automatically reduce balances, he wrote. Patients must first receive a bill and then apply for assistance through the agency’s Debt Adjudication Office.
“It is important for patients to understand there are two main pathways for financial relief,” Graves said.
The primary option is an income-based discount using a sliding fee scale, he wrote. Additional discretionary waivers may also be available after income-based reductions are applied.
Eligibility for discounts is based on household income compared with federal poverty guidelines issued annually by the Department of Health and Human Services.
Patients whose income falls at or below the federal poverty threshold may qualify for full relief, according to MHS. Those earning between 101% and 400% of the guideline may qualify to make nominal payments through interest-free installment plans lasting up to six years.
Patients with incomes between 401% and 600% of the guideline may qualify for reduced bills and similar installment options.
The federal poverty level for 2026 ranges from $15,960 for a single person to $55,720 for a family of eight, with $5,680 added for each additional household member.
