How to Use TRICARE with Other Health Insurance (OHI) | TRICARE.com

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## Quick answer In almost all cases, TRICARE pays **last**. If you have Other Health Insurance (OHI), your private or employer-sponsored plan must process the claim first; TRICARE then pays the remaining covered balance, often resulting in lower or zero out-of-pocket costs.

## Details Having Other Health Insurance (OHI) is common for military families where a spouse works in the private sector or for retirees who have a second career. By law, TRICARE is the secondary payer to all other health insurance plans except for Medicaid, TRICARE supplements, the Indian Health Service, and other programs as specifically named by the Defense Health Agency.

### How the Billing Process Works When you visit a provider, you must present both your OHI ID card and your military ID. 1. **The Primary Payer:** Your provider bills your private insurance first. 2. **The Explanation of Benefits (EOB):** Your private insurer pays their portion and sends you/the provider an EOB. 3. **The Secondary Payer:** Your provider (or you) submits the claim and the EOB from the primary insurer to your TRICARE regional contractor (**Humana Military** in the East; **TriWest Healthcare Alliance** in the West). 4. **The Final Payment:** TRICARE pays the remaining amount up to the TRICARE-allowable charge.

### The "Double Coverage" Benefit If your OHI is a high-deductible plan or has high co-pays, TRICARE often covers those costs. In many cases, between the two insurances, your out-of-pocket cost for a 2026 doctor’s visit will be $0. However, if your OHI does not cover a service that TRICARE does, TRICARE may pay as the primary payer for that specific service.

### Important Restrictions and Exceptions * **TRICARE Prime and OHI:** If you are enrolled in TRICARE Prime and have OHI, you can still use the OHI, but you must follow TRICARE Prime rules (like getting referrals) if you want TRICARE to pay its portion as the secondary payer. * **Pharmacy (Express Scripts):** Your private insurance must pay first for prescriptions. You can use the TRICARE Pharmacy Home Delivery (Express Scripts) only if your OHI doesn't have a mail-order benefit or if you’ve exhausted it. * **Mandatory Reporting:** You are legally required to notify TRICARE if you have other insurance. Failure to do so can result in "Coordination of Benefits" (COB) flags, which will cause your TRICARE claims to be denied until the information is updated.

## Who this affects * **Active Duty Family Members (ADFMs):** Commonly affected when a spouse has an employer-sponsored plan. * **Retirees and their Families:** Frequently applies to those with post-military "second career" insurance. * **National Guard and Reserve:** Beneficiaries using TRICARE Reserve Select who also have access to civilian employer plans. * **Survivors:** Eligible family members who have remarried or joined the private workforce.

## Sources * **TRICARE.mil:** [Using Other Health Insurance](https://www.tricare.mil/ohi) * **Humana Military (East):** [Coordination of Benefits](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (West):** [Provider Billing Resources](https://www.triwest.com) * **Express Scripts:** [TRICARE Pharmacy Benefit](https://militaryrx.express-scripts.com)