TRICARE Coordination of Benefits (COB) Explained | TRICARE.com

*Note: TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and the most current data, visit TRICARE.mil.*

## Definition Coordination of Benefits (COB) is the process TRICARE uses to ensure that when a beneficiary has more than one health insurance plan, the total payments from all plans do not exceed 100% of the allowed medical expenses.

## What it means in practice By federal law, TRICARE is the secondary payer to almost all other health insurance (OHI) plans. This means that if you have health insurance through an employer or a private policy, that company must process and pay your claim before TRICARE pays anything. The only exceptions where TRICARE pays first are Medicaid, TRICARE supplements, or the Indian Health Service.

In practice, if you visit a doctor for a $200 procedure, your OHI will process the claim first according to its specific coverage rules. If your OHI pays $120 and leaves you with an $80 balance, you (or your provider) then submit that Explanation of Benefits (EOB) to TRICARE. Under COB rules for 2026, TRICARE will typically pay the remaining "patient responsibility" up to the TRICARE-allowed amount, often resulting in $0 out-of-pocket costs for the beneficiary. However, if the OHI payment already exceeds what TRICARE would have allowed for that service, TRICARE will pay nothing additional.

It is critical that you notify your regional contractor (Humana Military in the East or TriWest Healthcare Alliance in the West) and Express Scripts for pharmacy benefits about your other insurance. If TRICARE pays a claim as the primary payer and later discovers you had OHI, they will initiate a "recoupment" process, requiring you or the provider to pay the money back. To avoid this, always present both insurance cards at the doctor’s office and the pharmacy.

For TRICARE For Life (TFL) beneficiaries, the COB order is typically: 1. Other Health Insurance (if applicable) 2. Medicare 3. TRICARE

## Related terms * **Other Health Insurance (OHI):** Any non-TRICARE health insurance you have through an employer or private purchase. * **Explanation of Benefits (EOB):** An itemized statement from an insurance company showing what was paid, what was denied, and what the patient owes. * **Secondary Payer:** The insurance plan that pays only after the primary insurance has processed the claim. * **Double Coverage:** A situation where a beneficiary is covered by two or more health insurance plans at the same time. * **Allowed Amount:** The maximum amount TRICARE will pay for a specific medical service or supply.

## Sources * TRICARE.mil: Using Other Health Insurance (https://www.tricare.mil/ohi) * Humana Military: Coordination of Benefits (https://www.humanamilitary.com/beneficiary/claims/coordination-of-benefits) * TriWest Healthcare Alliance: Claims and OHI (https://www.triwest.com/en/beneficiary/claims/)