TRICARE EOB Explained: Reading Your Statement | TRICARE.com

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## Quick answer A TRICARE Explanation of Benefits (EOB) is not a bill; it is a summary of how TRICARE processed a specific medical claim. It shows what the provider charged, what TRICARE paid, and exactly how much you—the patient—actually owe the doctor for copayments or deductibles.

Details

Whenever you see a doctor or fill a prescription, an EOB is generated after the claim is processed. You should compare your EOB against the billing statements you receive from your provider's office to ensure you aren't overcharged.

### Key Sections of the EOB * **Total Amount Charged:** The "sticker price" the doctor billed TRICARE. * **Allowed Amount:** The maximum amount TRICARE agrees to pay for that specific service based on contracted rates. * **Paid by TRICARE:** The actual dollar amount sent to the provider by Humana Military (East), TriWest (West), or Express Scripts (Pharmacy). * **Deductible:** The amount applied toward your annual deductible (e.g., your 2026 TRICARE Select deductible) before TRICARE begins cost-sharing. * **Patient Responsibility:** This is the most important number. It includes your copayment or cost-share. Do not pay more than this amount to your provider.

### Regional Differences (2026) Since Jan 1, 2025, TRICARE has operated under the T-5 contract. Your EOB will look different depending on your region: * **East Region:** Managed by **Humana Military**. You can view EOBs via their secure beneficiary portal. * **West Region:** Managed by **TriWest Healthcare Alliance**. Electronic EOBs are found on the TriWest portal. * **Pharmacy:** Managed by **Express Scripts**. These summaries often group multiple prescriptions together.

### Why You Might Receive an EOB for $0 If you are on **TRICARE Prime**, your EOB will often show $0 for patient responsibility because Prime has no point-of-service costs for most referrals. However, if you see a provider without a referral (Point of Service option), your EOB will reflect a 50% cost-share and a $300 individual deductible for 2026.

### Timelines and Disputes EOBs are typically available online within 7 to 10 days of a claim being finalized. If you see an error—such as a service you didn't receive or a "Patient Responsibility" amount that seems higher than your 2026 plan rates—you have 90 days to file a claim appeal with your regional contractor.

## Who this affects * **Retirees and their families:** Specifically those in TRICARE Select who have frequent cost-shares. * **Active Duty Family Members (ADFMs):** To track specialty care and pharmacy costs. * **National Guard and Reserve:** Those on TRICARE Reserve Select (TRS) to monitor deductible fulfillment. * **Active Duty Personnel:** Though they usually have $0 out-of-pocket, EOBs are generated to track clinical history and prevent fraud.

## Sources * **TRICARE.mil:** [Explanation of Benefits Overview](https://www.tricare.mil/eob) * **Humana Military (East):** [Claims and EOBs](https://www.humanamilitary.com/beneficiary/claims) * **TriWest Healthcare Alliance (West):** [Beneficiary Claims Portal](https://www.triwest.com) * **Express Scripts:** [Pharmacy Claim History](https://militaryrx.express-scripts.com)