TRICARE and Other Health Insurance (OHI) Rules 2026 | TRICARE.com

## Quick answer In most cases, TRICARE pays second to Other Health Insurance (OHI), such as employer-sponsored coverage or private plans. By law, TRICARE is the secondary payer, meaning you must file claims with your primary insurance first; TRICARE then covers remaining eligible costs, often resulting in little to no out-of-pocket expenses.

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Details

### How OHI Works with TRICARE Other Health Insurance (OHI) is defined as any health insurance you have that is not TRICARE. This includes insurance through your own employer, your spouse’s employer, or a private policy you purchased yourself. Under federal law, TRICARE is the "payer of last resort."

When you have OHI: 1. You visit your provider and present both insurance cards. 2. The provider bills your primary OHI first. 3. The OHI pays its portion and sends you an Explanation of Benefits (EOB). 4. TRICARE then pays the remaining "allowable charge" for covered services.

### Important Exceptions to the Rule There are three specific exceptions where TRICARE pays first, even if you have other coverage: * **Medicaid:** TRICARE always pays before Medicaid. * **TRICARE Supplements:** Plans specifically designed to wrap around TRICARE coverage pay after TRICARE. * **Indian Health Service (IHS):** TRICARE pays before IHS.

### Active Duty Service Members (ADSMs) Active duty service members (ADSMs) generally **cannot** use OHI as their primary insurance. By law, TRICARE is their only coverage for duty-related care, and any outside care must be coordinated through their primary care manager and the TRICARE regional contractor (Humana Military in the East or TriWest in the West).

### Pharmacy and Express Scripts If you have OHI with a pharmacy benefit, you must use that first. You can still use the TRICARE Pharmacy Home Delivery or retail network (managed by **Express Scripts**) to cover remaining costs, but you must inform them of your other coverage to ensure coordination of benefits.

### Enrollment and Reporting You are required by law to report OHI to TRICARE. Failure to do so can result in TRICARE denying your claims or seeking "recoupment" (demanding money back) for claims they paid that should have been covered by your primary insurance.

You can report OHI by: * Updating your information on the **MilConnect** website (DEERS). * Filling out the TRICARE Other Health Insurance Questionnaire and mailing it to your regional contractor.

## Who this affects * **Active Duty Family Members:** Often have coverage through a civilian employer. * **Retirees and their Families:** Frequently hold post-military civilian jobs with health benefits. * **National Guard and Reserve:** Use TRICARE Reserve Select (TRS) but may also have access to employer plans. * **TRICARE For Life (TFL) Users:** TFL always coordinates with Medicare; if a third "commercial" insurance is involved, TFL typically pays last.

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