When a beneficiary's health care services are covered by Medicare, TRICARE, and their Other Health Insurance (OHI), which payer acts last?

In the scenario where a beneficiary has coverage from Medicare, TRICARE, and an Other Health Insurance (OHI), TRICARE serves as the last payer in the claims process. This is due to the coordination of benefits that exists between these types of insurance.

Typically, Medicare is considered the primary payer because it is the federal program that pays first on any covered costs. The OHI usually acts as the secondary payer, stepping in to cover costs that Medicare does not fully cover. Consequently, any remaining balance after Medicare and the OHI have processed the claim falls to TRICARE as the last payer in this series.

This order ensures that the beneficiary maximizes their benefits while minimizing out-of-pocket expenses. By allowing TRICARE to process claims last, it can cover the remaining eligible expenses that are not satisfied by Medicare or the OHI, thus acting as a supplementary resource to the other forms of insurance.