TRICARE Contractors Hub: East & West Region Guides | TRICARE.com

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## Quick answer TRICARE is managed by private regional contractors who handle the "business" side of your healthcare, including processing claims, managing provider networks, and issuing referrals. As of 2026, the two primary regional contractors are **Humana Military** for the East Region and **TriWest Healthcare Alliance** for the West Region.

## In detail The Defense Health Agency (DHA) awards multi-year contracts (currently under the "T-5" contract cycle) to private companies to administer the TRICARE benefit. Understanding which contractor manages your area is vital for finding a doctor, checking the status of a claim, or resolving billing issues.

### The Two Domestic Regions The United States is divided into two geographic regions. Your primary contractor is determined by where you live, not where your sponsor is stationed (though these are usually the same).

| Feature | East Region | West Region | | :--- | :--- | :--- | | **Contractor** | Humana Military | TriWest Healthcare Alliance | | **Coverage Area** | 24 states in the Eastern/Southern US | 26 states in the Western/Midwestern US | | **Claim Submission** | Humana Military Claims | TriWest Health Care Claims | | **Network Management** | Humana Military Network | TriWest Network |

### Key Contractor Responsibilities * **Provider Networks:** Contractors negotiate rates with civilian doctors and hospitals to ensure you have "in-network" options. * **Referrals and Authorizations:** If you are on TRICARE Prime, the contractor reviews and approves your referrals for specialty care. * **Claims Processing:** When you see a civilian provider, the contractor pays the doctor and sends you an Explanation of Benefits (EOB). * **Customer Service:** Each contractor maintains its own call center and secure web portal for beneficiaries.

### Special Benefit Contractors While regional contractors handle medical care, specific benefits are managed by specialized nationwide contractors: * **Pharmacy (TDP):** Managed by **Express Scripts**. This covers home delivery and retail pharmacy networks. * **Dental (TDP/FEDVIP):** Managed by **United Concordia** (for active duty families) or via **FEDVIP** (for retirees). * **Overseas:** Managed by **International SOS (ISOS)** for all beneficiaries living outside the 50 United States.

### Contract Status (2026 Update) On January 1, 2025, the T-5 contract transition took place. A major change was West Region administration moving from Health Net Federal Services (HNFS) to **TriWest Healthcare Alliance**. Six states (Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin) also shifted from the West Region to the East Region as part of this transition.

## Who this applies to * **Active Duty Service Members:** Contractors manage your "fitness for duty" care when performed by civilian providers. * **Active Duty Families:** Use contractor portals to find PCM (Primary Care Manager) changes and track referrals. * **Retirees and Families:** Contractors manage the TRICARE Select network and process out-of-pocket cost shares. * **TRICARE Reserve Select (TRS) Members:** Enrollment and monthly premium billing are handled through the regional contractor’s portal.

Common scenarios

**Scenario 1: Finding a Specialist in San Diego** A Navy spouse in San Diego (West Region) needs an Orthopedist. She logs into the **TriWest** portal to search the "Provider Directory." Because she is on TRICARE Select, she chooses an in-network provider to keep her 2026 Group A specialist copay at $38 instead of the higher out-of-network rates.

**Scenario 2: Checking a Pharmacy Claim** A retiree in Florida (East Region) wants to see why their prescription cost more than expected. Even though they live in the East Region (Humana), they do not call Humana. Instead, they log into **Express Scripts** because pharmacy benefits are managed by a separate national contractor.

**Scenario 3: Moving from Maine to Arizona** An Army family moves from Maine (East) to Arizona (West). They must "transfer" their enrollment. They contact **TriWest** to establish their new Prime enrollment in the West. Their 2026 enrollment fees (if applicable for retirees) would be transferred and credited appropriately between the contractors.

## Related terms * **T-5 Contract:** The 5th generation of TRICARE contracts which began implementation in 2025. * **Explanation of Benefits (EOB):** A statement sent by the contractor explaining what was covered and what you owe. * **Network Provider:** A doctor who has a formal agreement with the regional contractor to provide care at discounted rates. * **Direct Care:** Care received inside a Military Treatment Facility (MTF) rather than through a contractor's civilian network. * **Point of Service (POS):** An option to see any provider without a referral, which involves higher costs processed by the contractor.

## Sources * [TRICARE.mil: TRICARE Regions](https://www.tricare.mil/About/Regions) * [Humana Military (East)](https://www.humanamilitary.com/) * [TriWest Healthcare Alliance (West)](https://www.triwest.com/) * [Express Scripts TRICARE](https://militaryrx.express-scripts.com/)