TRICARE EOB: Understanding Your Explanation of Benefits | TRICARE.com

An **Explanation of Benefits (EOB)** is a report sent by your TRICARE regional contractor (Humana Military or TriWest) that details what medical services were provided, how much TRICARE paid the provider, and exactly how much you are responsible for paying.

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

## Definition An EOB is a summary statement, not a bill, that explains how TRICARE processed a specific medical claim and what portion of the cost falls to the beneficiary.

## What it means in practice Every time you visit a doctor, urgent care center, or hospital using TRICARE, a claim is generated. Once that claim is processed, your regional contractor (Humana Military in the East or TriWest in the West) issues an EOB. This document is your primary tool for tracking your healthcare spending and ensuring you aren't overcharged by providers.

The EOB tells you four critical things: the "Allowed Amount" (the maximum rate TRICARE permits the doctor to charge), the "Paid Amount" (what TRICARE actually sent to the doctor), the amount applied to your annual deductible, and finally, your cost-share or copayment. For example, if a TRICARE Select beneficiary in Group A sees an in-network specialist in 2026, the EOB might show an allowed amount of $150, a TRICARE payment of $120, and a "Patient Responsibility" of $30. You should never pay a provider until you have cross-referenced their bill with your TRICARE EOB.

It is also the document used to track your progress toward your **Catastrophic Cap**. Every dollar marked as "Patient Responsibility" on your EOB counts toward this annual limit. For 2026, once your EOBs show that your cumulative out-of-pocket costs have hit the cap (which varies by plan and sponsor status), TRICARE will pay 100% of the allowed amount for covered services for the remainder of the calendar year.

You can access your EOBs online through your respective contractor's portal. Because they contain Protected Health Information (PHI), they are typically archived for several years. If you have "Other Health Insurance" (OHI) like a commercial plan through an employer, you will receive an EOB from that insurer first, which TRICARE then uses to process its portion of the claim as the secondary payer.

## Related terms * **Catastrophic Cap:** The maximum out-of-pocket amount a beneficiary pays each year for TRICARE-covered services. * **Cost-Share:** The percentage of the TRICARE-allowable amount that a beneficiary pays (common in TRICARE Select). * **Deductible:** A fixed amount beneficiaries must pay out-of-pocket each year before TRICARE begins to pay for covered services. * **Allowed Amount:** The maximum price TRICARE will pay for a specific medical service or procedure. * **Other Health Insurance (OHI):** Any non-TRICARE health insurance you have, which must pay claims before TRICARE in most scenarios.

## Sources * TRICARE.mil: Understanding the EOB - https://www.tricare.mil/EOB * Humana Military (East Region Contractor) - https://www.humanamilitary.com/ Beneficiary Portal * TriWest Healthcare Alliance (West Region Contractor) - https://www.triwest.com/ Beneficiary Portal