TRICARE East vs TRICARE West

TRICARE is the health care program for uniformed service members, retirees and their family members worldwide. The Department of Defense started using the name TRICARE in 1996, replacing CHAMPUS. While TRICARE is comprehensive, it’s divided into regions to help manage care. If you’ve ever wondered about the difference between TRICARE East and TRICARE West, you’re not alone.

These regions are managed by different contractors and have unique features that impact access to care, provider networks and customer service.

In this guide for TriCareRehabs.com, we’ll break down the key differences to help you understand which region you’re in and what you need to know about your benefits.

What is TRICARE?

Before we get into the regional differences, let’s start with what is TRICARE. TRICARE is a Department of Defense health agency to ensure active duty service members, national guard members, military members, retirees and their families receive medical care.

It offers various plans including TRICARE Prime, TRICARE Select, TRICARE for Life and more, each tailored to different needs. But depending on where you live, your health care coverage is under either TRICARE East or TRICARE West.

TRICARE Regional Breakdown

TRICARE is divided into two main regions in the US: TRICARE East and TRICARE West. This helps streamline administrative processes, provider networks and customer support. Your region is determined by your physical address, not where you receive care.

• TRICARE East covers states in the eastern half of the US
• TRICARE West covers states in the western half of the US

Each region has a TRICARE contractor responsible for managing benefits, processing claims and handling customer service inquiries. These contractors deliver essential support and resources to customers to ensure TRICARE is accessible and effective.

Key Difference Between TRICARE East and TRICARE West

While TRICARE coverage is the same across regions, the main differences are in administrative management, provider networks and regional policies. Both regions offer various types of care and providers including network and non-network options. Below we break down the differences.

1. Regional Contractors: Humana Military

The biggest difference between TRICARE East and TRICARE West is the region contractor. The two regions and their assigned contractors are as follows:

• TRICARE East is managed by Humana Military.
• TRICARE West is managed by Health Net Federal Services (HNFS).

These contractors process claims, establish provider networks and handle customer service. Depending on where you live, you’ll work with the corresponding contractor for all TRICARE issues.

2. States Covered: Missouri, Alaska, North Dakota, California

Your region is determined by your home address. Here’s the breakdown of states in each region:

• TRICARE East: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin and the District of Columbia.
• TRICARE West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington and Wyoming.

3. Provider Networks and Availability

Both TRICARE East and TRICARE West have large provider networks but availability varies by location.

• TRICARE East (Humana Military) has a larger provider network in the eastern US, including urban areas.
• TRICARE West (Health Net Federal Services) covers more rural and remote areas where provider availability may be more limited.

If you live in an area with fewer in-network providers, you may need referrals for specialty care or use TRICARE Select for more flexibility.

4. Customer Service and Support

Each region has its own customer service contact information and online portal for beneficiaries. If you are not sure how to get in contact with your insurance provider, a Tricare Rehabs representative can help you verify your coverage and benefits.

5. Referral and Authorization Processes

TRICARE has standard policies but the process for referrals and authorizations vary by region.

• TRICARE Prime beneficiaries need referrals for specialty care. The regional contractor processes these referrals and assigns an in-network provider.
• TRICARE Select beneficiaries do not need referrals but may have different cost-sharing for in-network or out-of-network providers.

Both Humana Military (East) and Health Net Federal Services (West) have online portals where beneficiaries can check referral and authorization status.

6. Claims Processing and Reimbursement

Each regional contractor processes claims separately.

• TRICARE East Claims:
  • Claims are processed by Humana Military.
  • Electronic claims can be submitted on the Humana Military website.
• TRICARE West Claims:
  • Claims are handled by Health Net Federal Services.
  • Claims can be submitted electronically through the TRICARE West portal.

If you receive care outside the TRICARE network, you may need to submit a claim for reimbursement. Follow your region’s submission process to avoid delays.

TRICARE Region Changes in 2025

In 2025, TRICARE will undergo major changes to its regional structure to improve service and balance the TRICARE population. Six states currently in the East Region—Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin—will transition to the West Region. This affects about 1.1 million eligible beneficiaries.

Starting January 1, 2025, the TRICARE regional contractor for these states will be TriWest Healthcare Alliance. TriWest Healthcare Alliance, a trusted healthcare alliance, will manage benefits, claims and customer service for these states. Beneficiaries in these states should update their information in DEERS by December 31, 2024 to ensure a smooth transition and continuous access to care.

Health Care Options in TRICARE Regions

TRICARE has options for its beneficiaries based on their region. In the TRICARE East Region, managed by Humana Military, beneficiaries have access to a network of civilian providers, military hospitals and clinics. In the TRICARE West Region, managed by TriWest Healthcare Alliance, beneficiaries can also access care through a network of civilian providers, military hospitals and clinics.

To find a provider in your region, use the “Find a Doctor” tool on the TRICARE website. The “TRICARE Covered Services” tool lets you check if a specific service is covered under your plan. For those looking to compare costs, the “TRICARE Compare Costs” tool provides details on covered services, enrollment fees and plan premiums.

Knowing your options and using these resources can help you make informed decisions about your care. Stay informed about TRICARE region changes and know your health care options to ensure you and your family get the best care.

Choosing the Right TRICARE Plan for Your Region

Regardless of whether you are in TRICARE East or TRICARE West, your coverage is the same. But factors like provider availability, customer service and claims processing can impact your experience. When you move to another region, you must update your address in DEERS (Defense Enrollment Eligibility Reporting System) to ensure continuous coverage.

Figure Out Your Tricare Coverage Options

Understanding the difference between TRICARE East and TRICARE West can help you navigate your military benefits better. Coverage is the same across regions but contractors, provider networks and administrative processes are different. Know your region and how to access care in your network and you and your family will get the best health care.

If you have questions about your coverage, you can contact a Tricare Rehabs representative today. We can go over your insurance and determine what benefits are included in your health plan.

All calls are confidential, so please reach out to get proven support options with us now.