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Anthem and TRICARE: How Coordination of Benefits Works

Comprehensive guide to how Anthem private insurance works with TRICARE, including rules for Other Health Insurance (OHI) and 2026 coordination of benefits.

Anthem and TRICARE: How Coordination of Benefits Works

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## Quick answer Anthem is a private health insurance company that does not manage TRICARE directly. However, Anthem (and its parent company, Elevance Health) often provides the underlying network of civilian providers that TRICARE contractors use to deliver care. Most importantly, if you have Anthem through a civilian employer while also using TRICARE, Anthem is considered your "Other Health Insurance" (OHI) and must pay your medical claims first.

In detail

### The Relationship Between Anthem and TRICARE Anthem is not a TRICARE plan. TRICARE is managed by the Department of Defense through regional contractors: * **East Region:** Humana Military * **West Region:** TriWest Healthcare Alliance (as of January 1, 2025)

While these companies hold the primary contracts, they often lease or partner with established provider networks to ensure military families can find doctors nearby. Anthem’s wide network is frequently utilized in sub-contracting arrangements, meaning your "TRICARE doctor" might also be an "Anthem doctor."

### Anthem as Other Health Insurance (OHI) If you are a military retiree or a family member with a civilian job that provides Anthem insurance, federal law dictates the order of payment. With the exception of Medicaid and TRICARE supplements, **TRICARE pays last.**

1. **Primary Payer:** Anthem (Your employer-sponsored insurance). 2. **Secondary Payer:** TRICARE (Covers remaining out-of-pocket costs, deductibles, and cost-shares up to the TRICARE allowable amount).

### TRICARE Select vs. Anthem If you have the choice between enrolling in an Anthem plan at work or using TRICARE Select, consider these 2026 factors: * **Premiums:** TRICARE Select premiums for Group A retirees are approximately $190.32/individual or $380.64/family (2026 rates). If your Anthem premium is higher, many beneficiaries choose the "TRICARE-only" route. * **The "Double Coverage" Benefit:** Having both means you may pay $0 out-of-pocket for most services, as TRICARE often picks up the deductible and co-pay left over by Anthem.

### Coordination of Benefits (COB) To use Anthem and TRICARE together, you must: 1. **Notify TRICARE:** Report your Anthem coverage via the DEERS (Defense Eyecar Enrolment Reporting System). 2. **Tell your Doctor:** Provide both insurance cards at the front desk. 3. **File Claims:** Anthem will process the claim and generate an Explanation of Benefits (EOB). Your TRICARE regional contractor (Humana Military or TriWest) uses that EOB to pay its portion.

## Who this applies to * **Active Duty Family Members (ADFMs):** If a spouse has Anthem through their employer, it acts as the primary insurance. * **Military Retirees:** Common among those who start a second career in the private sector and receive Anthem benefits. * **TRICARE Reserve Select (TRS) Members:** Traditional guardsmen or reservists who may have Anthem through their civilian "day job." * **Providers:** Doctors who are in-network with Anthem but want to know how to bill TRICARE for the remaining balance.

Common scenarios

### Scenario 1: Retiring to a Civil Service Job John is a 44-year-old retiree living in Virginia (East Region). He takes a job that offers an Anthem PPO. He takes his child to a specialist. The specialist's bill is $200. * **Anthem (Primary):** Pays $140 based on its contracted rate. * **Patient Responsibility:** $60. * **TRICARE (Secondary):** John submits the Anthem EOB to Humana Military. TRICARE covers the remaining $60. John pays **$0**.

### Scenario 2: Active Duty Spouse with OHI Sarah is married to an active-duty sailor in San Diego (West Region). She has Anthem insurance through her corporate job. She visits a doctor for an illness. * **Anthem:** Pays its portion first. * **TRICARE:** TriWest pays the remainder of the covered amount. * **Important:** Even though Sarah is active duty family (who usually have no copays), she must use her Anthem OHI first.

## Related terms * **Other Health Insurance (OHI):** Any non-TRICARE health insurance you have through an employer or private purchase. * **Explanation of Benefits (EOB):** The document insurance companies send explaining what they paid and what you owe. * **T-5 Contract:** The fifth generation of TRICARE contracts which transitioned the West Region to TriWest in 2025. * **Allowable Amount:** The maximum amount TRICARE will pay for a specific medical service. * **Coordination of Benefits (COB):** The process of determining which insurance company pays first when a patient has multiple plans.

## Sources * **TRICARE.mil - Using Other Health Insurance:** https://www.tricare.mil/ohi * **Humana Military (East Contractor):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West Contractor):** https://www.triwest.com/ * **Defense Health Agency (DHA):** https://health.mil/dha