Humana TRICARE Guide: East Region Coverage & Costs | TRICARE.com

Learn about Humana Military's role as the TRICARE East Region contractor, including coverage areas, 2026 fees, and how to manage claims and referrals.

Humana TRICARE Guide: East Region Coverage & Costs

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## Quick answer Humana Military (a subsidiary of Humana Inc.) is the TRICARE regional contractor for the **East Region**. If you live in one of the 24 eastern states or Washington, D.C., Humana is the company that manages your provider network, processes your medical claims, and handles your customer service and authorizations.

In detail

As the East Region contractor under the Department of Defense T-5 contract, Humana Military serves approximately 6 million beneficiaries. Their primary role is to bridge the gap between military hospitals (MTFs) and civilian healthcare providers.

### Responsibilities of Humana Military * **Network Management:** Humana recruits and maintains the civilian network of doctors, specialists, and hospitals. * **Claims Processing:** When you see a civilian doctor in the East Region, that doctor bills Humana Military for payment. * **Referrals and Authorizations:** Humana reviews requests from Primay Care Managers (PCMs) to ensure specialty care is medically necessary and covered. * **Customer Service:** They operate the call centers and online portals where beneficiaries track their health records and explanation of benefits (EOB).

### Coverage Area (The East Region) The East Region managed by Humana includes: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (only the eastern part), Vermont, Virginia, West Virginia, Wisconsin, and the District of Columbia.

### 2026 Costs and Fees Costs are determined by the beneficiary's category (Group A or Group B) and their specific plan, not by Humana directly. However, Humana is responsible for collecting these fees:

*Note: 2026 rates are subject to annual COLA adjustments. Check the Humana Military portal for your specific "catastrophic cap" progress.*

## Who this applies to * **Active Duty Service Members (ADSMs):** Stationed in the East Region; Humana manages their supplemental care when MTFs are unavailable. * **Active Duty Family Members (ADFMs):** Living in the East; they interact with Humana for Prime specialist referrals or Select civilian claims. * **Retirees and their Families:** Those living in the East Region who pay enrollment fees directly to Humana Military. * **TRICARE Reserve Select (TRS) Members:** Reservists in the East who pay monthly premiums to Humana to maintain coverage.

Common scenarios

### 1. Seeking a Specialist (Prime) John is a retired Navy Chief living in Virginia (East Region) on TRICARE Prime. His doctor wants him to see a cardiologist. The doctor sends a request to **Humana Military**. John logs into his Humana Military account 48 hours later to see his "Authorization Letter," which tells him exactly which civilian cardiologist he is approved to see.

### 2. Filing a Claim (Select) Sarah is an Army spouse in Florida using TRICARE Select. She visits a local civilian urgent care center. Because she is in the East Region, the urgent care center sends the bill to Humana Military. Sarah pays her 2026 copayment (typically around $30–$40 for Select Group A) at the door, and Humana pays the remainder to the clinic.

### 3. Moving Regions Major Miller moves from South Carolina (Humana/East) to California (TriWest/West). He must contact the Global Distance Learning Center or use the BRS to switch his enrollment. His records will transition from Humana’s system to TriWest’s system, as Humana does not manage care in the West.

## Related terms * **T-5 Contract:** The fifth generation of TRICARE contracts (started Jan 1, 2025) that defined Humana's current role in the East. * **TriWest Healthcare Alliance:** The contractor responsible for the **West Region**; Humana’s counterpart. * **Explanation of Benefits (EOB):** The document Humana sends you after a doctor visit explaining what they paid and what you owe. * **PCM (Primary Care Manager):** The doctor Humana assigns to you (or you choose) to coordinate your care. * **Network Provider:** A doctor who has a formal contract with Humana Military to accept TRICARE allowable charges.

## Sources * **TRICARE.mil - East Region:** https://www.tricare.mil/About/Regions/East * **Humana Military Official Site:** https://www.humanamilitary.com/ * **Defense Health Agency - T-5 Contract Info:** https://health.mil/Military-Health-Topics/Business-Support/Contracting/T5-Contract-Transition