# Stop Copay Overpay Act: Plain Language Summary

This bill makes mental health care more affordable for military families and retirees covered by TRICARE, the military's health insurance program. Right now, TRICARE charges different copayments depending on the type of care you're getting. Mental health visits sometimes cost more than regular doctor visits, which can discourage people from seeking the mental health treatment they need. This bill fixes that by capping mental health copayments at the same rate as primary care visits. So if a regular checkup costs $25, a therapy session or psychiatry appointment also costs $25, no matter which doctor provides it. This applies to everyone enrolled in TRICARE—active duty service members, retirees, their families, and survivors.

The bill also includes a temporary freeze on other specialty care copayments for one year. During this period, the Department of Defense cannot raise what you pay for specialty services like dermatology or orthopedics beyond what they charged in 2021. This gives Congress time to study whether the mental health copayment changes create any problems in the military health system before deciding on permanent rules for other specialties.

The practical effect is straightforward: military families will save money when getting mental health care, making it easier to afford counseling, therapy, or psychiatric visits without worrying about higher copayments. The bill requires the Defense Department to report back to Congress within a year about how these changes affect the military health system, so lawmakers can decide whether to make similar protections permanent for other types of specialty care.

Stop Copay Overpay Act

Houlahan, Chrissy

Stop Copay Overpay ActThis bill prohibits the Department of Defense (DOD) from charging a covered individual (i.e., individuals enrolled under the TRICARE program) a co-payment exceeding a certain rate for an outpatient visit for mental health or behavioral health under the TRICARE program, regardless of whether the visit is furnished by a specialty care provider. Specifically, the co-payment amount may not exceed the amount of a co-payment that would be charged under the TRICARE program for an outpatient visit for primary care services.During the one-year period beginning after this bill is enacted, DOD may not increase the co-payment amount charged to a covered individual above the amount that would have been charged in FY2021&nbsp;for any service (1) furnished by a specialty care provider under the TRICARE program, and (2) that is not an outpatient visit for&nbsp;mental or behavioral health care.&nbsp;