What is the difference between TRICARE East and West?

TRICARE is the health care program for uniformed service members, retirees, and their families. Up until 2018, TRICARE was divided into three regions – North, South, and West. In 2018, the regions were consolidated into two – East and West. TRICARE East and West are managed by different contractors, cover different geographic areas, and have some differences in plans and costs.

The Basics of TRICARE Regions

Here is a quick overview of how the TRICARE regions are structured:

• TRICARE East – Managed by Humana Military. Covers the eastern half of the U.S.
• TRICARE West – Managed by Health Net Federal Services. Covers the western half of the U.S.
• TRICARE Overseas – Managed by International SOS. Provides coverage overseas.

The regions were consolidated to provide more consistency in plans and benefits across the program. However, there are still some differences between East and West in terms of contractor, geographic area, and costs. The overseas program has the most differences as a global system.

Key Differences Between TRICARE East and West

While TRICARE East and West provide the same basic health plans and benefits, there are some key differences:

Contractors

• TRICARE East – Humana Military has been the managed care support contractor for the East region since the consolidation in 2018. Prior to that, the East region was split between Humana Military and Health Net Federal Services when it was the North and South regions.

• TRICARE West – Health Net Federal Services has been the contractor for the West region since the consolidation. They also previously managed the West region before consolidation.

Geographic Regions Covered

• TRICARE East – Covers the eastern half of the continental U.S., including the Northeast, Southeast, and Mid-Atlantic. It also covers Puerto Rico and the Virgin Islands.

• TRICARE West – Covers the western half of the continental U.S., including the Northwest, Southwest, and Midwest. It also covers Alaska and Hawaii.

• TRICARE Overseas – Covers U.S. territories like Guam as well as countries in Europe, Africa, Latin America, Asia, and the Pacific.

Plan Options

• The health plan options are mostly identical between regions, including Prime, Select, Reserve Select, Retired Reserve, Young Adult, and TRR premium plans.

• Overseas Prime and Select Overseas have some differences compared to stateside plans. There are also additional plan options only for overseas coverage.

• The US Family Health Plan is only available in certain East coast areas near medical centers.

Costs

• Premiums, deductibles, and copays for the various TRICARE plans are mostly the same between regions.

• However, there can be slight differences in some costs between East versus West regions.

• Overseas plans tend to have higher out-of-pocket costs than stateside plans.

Referrals and Authorizations

• Requirements for referrals and authorizations are very similar between East and West regions.

• Overseas regions may have some differences in referral procedures based on local care systems.

Pharmacy Benefits

• Pharmacy coverage and copays are standardized across East and West regions for military pharmacies and the TRICARE Pharmacy Home Delivery program.

• The TRICARE retail pharmacy networks differ between Humana Pharmacy (East) and Express Scripts (West). Copays at retail pharmacies in the U.S. are the same.

How to Determine Your TRICARE Region

It’s important to know what TRICARE region you live in to ensure you contact the right contractor for assistance and enroll in the correct plans. Here are some tips:

• For stateside regions – Check a TRICARE map to see if you reside in the East or West region. It’s split roughly east and west of the Mississippi River.

• For overseas regions – TRICARE overseas regions are based on geographic commands – Eurasia-Africa, Latin America/Canada, and Pacific.

• Check your ZIP code – You can enter your ZIP code on the TRICARE website to determine your region.

• Contact your contractor – Call or go online to verify if Humana Military (East) or Health Net (West) serves your area.

• Check enrollment paperwork – Documentation you receive when enrolling in a TRICARE plan will state the managing contractor.

• Ask your military treatment facility – Stop by or call the MTF pharmacy, health clinic, or benefits office to confirm which region you are in.

• Look for contractors’ signs – Signs for Humana or Health Net at military clinics indicate the TRICARE contractor for that region.

What Each TRICARE Contractor Does

While TRICARE is managed overall by the Defense Health Agency, the contractors in each region play important roles:

Humana Military (East)

• Manages provider networks.
• Processes authorizations and referrals.
• Provides customer service.
• Handles claims.
• Manages clinical quality and grievances.
• Offers educational resources.

Health Net Federal Services (West)

• Manages provider networks.
• Processes authorizations and referrals.
• Provides customer service.
• Handles claims.
• Manages clinical quality and grievances.
• Offers educational resources.

International SOS (Overseas)

• Manages provider networks overseas.
• Processes overseas authorizations and referrals.
• Provides overseas customer service.
• Handles overseas claims.
• Manages clinical quality and grievances overseas.

While they provide mostly parallel services, each contractor has their own provider networks, customer service resources, and communication programs uniquely tailored to their region.

Impacts of Switching Regions

Since TRICARE East and West have separate contracts and systems, it can result in some changes when you move from one region to the other:

• You may need to enroll in plans with the new contractor.

• Your regional provider network will change.

• You will need to get new referrals and authorizations.

• You will have a different customer service contact.

• Copays and costs may be slightly different.

To transition between regions smoothly:

• Verify you are enrolled in the correct plans with the new contractor.

• Set up new providers covered in the new network.

• Obtain new referrals and pre-authorizations.

• Get new prescription refills transferred if needed.

• Confirm billing and reimbursement procedures.

• Update your contact info with the new contractor.

How to Get Information on TRICARE Regions

If you have questions about TRICARE’s regions, here are some resources:

• TRICARE Website – Provides overview maps and details on East, West, and overseas regions.

• ** contractors Website** – Humana Military and Health Net have tools to determine your region.

• TRICARE Publications – Handbooks and fact sheets explain the differences between programs in each region.

• TRICARE Representatives – Contact customer service for your specific region to get information.

• Military Treatment Facilities – Stop by or call MTFs to speak with TRICARE representatives on-site.

• Identification Cards – Your military ID card will display your TRICARE region.

• TRICARE Briefings – Attend briefings at your military base for updates when relocating between regions.

Understanding which TRICARE region you are in allows you to access the correct plans, providers, and services. While there are many similarities across regions, knowing the differences is crucial to utilizing your benefits smoothly. Keep your region information handy whenever using your TRICARE health benefits.

Frequently Asked Questions (FAQs)

Below are answers to some frequently asked questions about TRICARE’s East, West, and overseas regions:

Q: How are network providers different between regions?

A: Each TRICARE contractor establishes its own network of authorized providers in its region. There is some overlap, but providers may be in-network in one region but out-of-network in another.

Q: Do I have to re-enroll when moving between regions?

A: In most cases, yes you will need to re-enroll in plans with the new contractor when switching regions.

Q: Will my referrals and authorizations transfer between regions?

A: No, referrals and authorizations are specific to each contractor and region. You’ll need to get new ones when you move.

Q: Do deductibles and costs reset if I change regions mid-year?

A: No, deductibles, out-of-pocket maximums, and benefit limits will carry over if you transfer regions mid-year.

Q: Does my pharmacy coverage change between regions?

A: The retail pharmacy network changes based on contractor, but costs and TR