Can your TRICARE coverage work with other health insurance? > TRICARE Newsroom > Articles

Are you a beneficiary of TRICARE? Do you have other health care coverage in addition to your TRICARE plan? You may have employer-sponsored coverage or government health care plans. Or maybe you purchased additional coverage from private providers. Students may have health care coverage through their school. These supplemental plans are known as Other Health Insurance (OHI). If you have OHI, it’s important to know how you can use it with TRICARE.

“TRICARE beneficiaries with other health insurance should learn how it works in tandem with your TRICARE benefits,” said Shane Pham, TRICARE policy and program analyst at the Defense Health Agency. “Using your OHI and TRICARE correctly could save you time and money.”

Here are several facts about IHO that you need to know.

Why is it important to declare your OHI

If you add, remove or modify OHI, you must notify TRICARE and all designated suppliers to avoid future claim issues. Notifying TRICARE and your supplier of any IHO updates prior to any scheduled appointment will help process your claims faster. This will also reduce the possibility of subsequent refusals. The more information you provide about your IHO, the more accurate and quick the response to your request will be.

Also be sure to follow your IHO rules. If your IHO does not pay your claim because you did not follow its rules, TRICARE may not pay your claim. If TRICARE receives your request before your IHO processes it, TRICARE will refuse it.

How to declare your IHO

You can declare your IHO using one of the options below:

Remember to keep your IHO information up to date. This will help you get the most out of your edge.

How changes in your IHO could affect your registration

Winning or losing OHI counts as a Qualifying Life Event (QLE). A QLE allows you to register for TRICARE Prime or TRICARE Select outside of TRICARE Open Season. This does not apply to you if you are an Active Duty Service Member (ADSM) or have TRICARE For Life. Keep in mind that you have 90 days after losing or winning OHI to change your TRICARE health plan.

Which plan pays first

TRICARE and your IHO work together to coordinate your benefits for payment. By law, TRICARE pays after your OHI. If you have health coverage through an employer, private insurer, or school, your OHI is still your primary insurance. It pays all claims before TRICARE. If TRICARE receives your request before your IHO processes it, TRICARE will refuse it. The only exceptions to this rule are if you have:

  • Medical help
  • TRICARE Supplements
  • State compensation programs for victims of crime
  • Other federal government programs identified by the Defense Health Agency

Additionally, if you have exhausted your OHI benefits, TRICARE becomes the primary payer. In this case, you may need additional recommendations or prior authorization. And a TRICARE Authorized Provider, in-grid or out-of-grid, must be the one providing the services. ADSMs cannot use OHI as primary insurance. If you are on active duty, TRICARE is your only coverage.

IHO and Medicare

TRICARE pays after Medicare and your OHI for services covered by TRICARE. As noted in the TRICARE Handbook for Life, how Medicare coordinates with OHI depends on whether you have OHI based on your current job. But either way, TRICARE pays last. Visit the Medicare website for more information on how Medicare works with other insurance.

IHO with Pharmacy Benefits

When you have OHI with Pharmacy Benefits, your OHI pays first and TRICARE pays second. You can avoid higher costs by having your prescriptions filled at a pharmacy in the TRICARE retail network that is also part of your OHI network.

OHI and single ex-spouses

As a single ex-spouse, you may lose your eligibility for TRICARE if you enroll in and are covered by an employer-sponsored health insurance plan.

To learn more about TRICARE and IHO, see the information on the TRICARE website. You can also contact your TRICARE contractor if you have any questions.

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