TRICARE and Employer Insurance: How Coordination of Benefits Works

*TRICARE.com is an independent reference site and is not an official government platform. For official policy and enrollment, visit TRICARE.mil.*

## Quick answer If you have both TRICARE and employer-sponsored health insurance, TRICARE acts as the **secondary payer** by law. Your employer’s insurance must pay its portion of the bill first, and TRICARE will then cover the remaining authorized costs, often resulting in little to no out-of-pocket expense for you.

Details

When you have multiple health insurance plans, it is known as Other Health Insurance (OHI). Under federal law (10 U.S.C. § 1079 and 1086), TRICARE cannot pay until your private health insurance has processed the claim.

### How the Payment Process Works 1. **Primary Payer:** Your employer-sponsored insurance (OHI) receives the bill first. They pay their share according to your plan’s benefits. 2. **Secondary Payer:** TRICARE receives the claim after the OHI has paid. TRICARE typically covers the remaining deductible or cost-shares for TRICARE-covered services. 3. **The Result:** Families with OHI often find that their total out-of-pocket costs are effectively zero, as TRICARE "picks up the tab" for what the private insurer left behind.

### Important Exceptions to the Rule While TRICARE is usually secondary, there are two major exceptions where TRICARE pays first: * **Medicaid:** TRICARE is always primary to Medicaid. * **TRICARE Supplemental Insurance:** These are specific private plans designed only to wrap around TRICARE; they always pay after TRICARE.

### Managed Care Conflict: TRICARE Prime vs. OHI Using TRICARE Prime (the HMO-style plan) alongside an employer-sponsored HMO can be complex. TRICARE Prime requires you to use a Primary Care Manager (PCM). If you visit a doctor for your employer's plan without a PCM referral, TRICARE will process the claim under **Point of Service (POS) charges**, which include a $300 deductible and 50% cost-shares (2026 rates).

**Pro Tip:** Most beneficiaries with employer coverage choose **TRICARE Select**. Because Select does not require referrals, it coordinates much more smoothly with private PPO plans.

### Mandatory Reporting You are required by law to report Other Health Insurance to your regional contractor (Humana Military in the East or TriWest in the West). If you do not report your OHI, TRICARE will likely deny your claims, suspecting another payer should have been involved. You can update this via the "Patient Information" section on the contractor's secure portal.

## Who this affects * **Active Duty Family Members (ADFMs):** Spouses who work and have their own company plan. * **Retirees under age 65:** Retirees in second careers often have a high-deductible employer plan and use TRICARE Select as a safety net. * **National Guard and Reserve:** Members using TRICARE Reserve Select (TRS) who may also be offered a civilian employer plan. * **Survivors:** Spouses of deceased service members who are employed.

## Sources * **TRICARE.mil:** Using Other Health Insurance (https://www.tricare.mil/ohi) * **Defense Health Agency (DHA):** Rights and Responsibilities (https://health.mil) * **TriWest Healthcare Alliance:** West Region OHI Coordination (https://www.triwest.com) * **Humana Military:** East Region Claims Processing (https://www.humanamilitary.com)