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

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## Quick answer Humana Military is the regional contractor for the TRICARE East Region, covering 32 states in the Eastern U.S. They are responsible for managing the provider network, processing claims, and providing customer service to millions of active-duty members, retirees, and their families. If you live in the East Region, Humana Military is the company that handles your medical referrals and clinical North American operations.

## In detail Humana Military has served as the TRICARE East Region contractor for several contract cycles, including the current T-5 contract. They work under the direction of the Defense Health Agency (DHA) to ensure beneficiaries have access to civilian healthcare when military hospitals (MTFs) are unavailable.

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

### Key Responsibilities * **Provider Network:** Humana Military maintains the "Network" of doctors, hospitals, and specialists who agree to TRICARE's payment rates. * **Claims Processing:** When you see a civilian doctor, that doctor bills Humana Military directly. * **Referrals and Authorizations:** If you are on TRICARE Prime, Humana Military reviews and approves requests from your Primary Care Manager (PCM) to see a specialist. * **Customer Service:** They operate the primary call centers and web portals for East Region enrollment and billing questions.

### 2026 Plan Costs and Enrollment Costs depend on your "Group" (determined by when you or your sponsor joined the military) and your specific plan.

| Plan Type | Enrollment Fee (Retirees/Groups) | Typical Network Copay (2026) | | :--- | :--- | :--- | | **TRICARE Prime** | Required for Retirees/Families | $0 for ADSM/ADFM; ~$38+ for Retirees | | **TRICARE Select** | Required for Group A Retirees | Fixed Copays (e.g., $30–$50 per visit) | | **TRICARE For Life** | None (Requires Medicare Part B) | Usually $0 after Medicare pays |

*Note: Active Duty Service Members and their families typically have $0 out-of-pocket costs for covered services when using the Humana Military network with proper referrals.*

## Who this applies to * **Active Duty Service Members (ADSMs):** Who need specialty care outside of a military clinic in the East Region. * **Active Duty Family Members (ADFMs):** Living in the East Region using Prime or Select. * **Retirees and their Families:** Under age 65 who are enrolled in TRICARE Prime or Select within the 32-state East boundary. * **TRICARE Reserve Select (TRS) Members:** Reservists and Guardsmen purchasing coverage while living in the East. * **Young Adults:** Children of sponsors up to age 26 using TRICARE Young Adult (TYA) in the East.

Common scenarios

**1. The Specialist Referral (Prime)** Sgt. Miller lives in Virginia (East Region) and is on TRICARE Prime. His military doctor refers him to a civilian cardiologist. Humana Military processes the authorization. Because Sgt. Miller is Active Duty, his 2026 copay is **$0**, provided he waits for the Humana Military approval letter before the appointment.

**2. The Urgent Care Visit (Select)** A retired Petty Officer in Florida is on TRICARE Select. On a Saturday in 2026, he takes his daughter to a civilian network urgent care center. Because he is on Select, he does not need a referral. He pays a fixed network copay (typically around **$37–$40 for retirees in 2026**) which is processed through Humana Military.

**3. Moving from West to East** A family moves from California (West Region/TriWest) to North Carolina (East Region/Humana Military). They must contact Humana Military to update their enrollment. Their medical records remain in the DEERS system, but their new primary care manager and all future claims will now be managed by Humana Military.

## Related terms * **T-5 Contract:** The fifth generation of TRICARE contracts which standardized benefits across Humana Military (East) and TriWest (West). * **PCM (Primary Care Manager):** The doctor assigned to you (often at an MTF) who coordinates your care through Humana Military. * **DEERS:** The global database (Defense Enrollment Eligibility Reporting System) that tells Humana Military if you are eligible for benefits. * **Network Provider:** A civilian doctor who has a signed contract with Humana Military to accept TRICARE's negotiated rates. * **Authorization:** Official approval from Humana Military required for specific services or procedures before they happen.

## Sources * **TRICARE East Region official page:** https://www.tricare.mil/East * **Humana Military official site:** https://www.humanamilitary.com/ * **Defense Health Agency (DHA):** https://health.mil/