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Can I Have TRICARE for Life and Medicare?

Are you or a loved one looking to find out what additional coverage you can obtain once you are Medicare-eligible? Find out more about TRICARE for Life and how you can use it to supplement your Medicare coverage.

What Is TRICARE for Life?

TRICARE for Life, or TFL, is Medicare-wraparound coverage for any TRICARE-eligible beneficiaries with Medicare Part A and B coverage. It helps cover medical costs for active duty and retired military personnel and their families.

Will I Need to Enroll in TRICARE for Life?

Enrollment is automatic for those with Medicare Part A and B coverage. You are required to pay your Medicare Part B premiums.

Do I Have Access to TRICARE for Life Outside of the U.S.?

TRICARE is the secondary carrier after Medicare in all the U.S. and its U.S. Territories. TFL becomes the primary payer in any other overseas areas.

What Providers Can I Visit with TRICARE for Life?

You can visit the following providers and facilities with your TFL coverage:

*Any Medicare-participating providers
*Any Medicare non-participating providers
*Military hospitals and clinics, though only on a space-available basis

How Would My TRICARE for Life and Medicare Claims Be Handled?

You provider must file any medical claims from your visit with Medicare. After Medicare pays their portion, they should send the claims to a TFL claims processor.

For those with other health insurance (OHI), Medicare will send the claims to that carrier. You will be responsible for filing claims with Tricare for any costs not covered by your OHI. TRICARE will make payments directly to the provider for any eligible services.

Who Manages TRICARE for Life?

The Department of Defense manages TRICARE, while the Centers for Medicare & Medicaid Services (CMS) handles Medicare. Both agencies work together to coordinate benefits for your medical services.

What If I Only Have Medicare Part A?

You must have both Medicare Part A and B to be eligible for TRICARE for Life. Make sure you understand how the cost of Medicare affects your eligibility.

How Do TRICARE for Life and Medicare Work Together?

You should have no costs related to medical care when you have both Medicare and TRICARE. There may be times when a service may only be covered by one or the other, or not eligible for payment at all. That would make you responsible for any deductibles and cost-shares.

What Care Is Covered by Both Medicare and TRICARE for Life?

You will have no out-of-pocket costs if you visit a Medicare provider, participating or non-participating, for any medically necessary care eligible under both carriers. Medicare determines whether care rendered was medically necessary. TFL defaults to Medicare’s final evaluation.

*If the care is medically necessary: Medicare pays first for its portion of a claim. TRICARE covers the remaining balance if the services are TRICARE-eligible.
*If the care is not medically necessary: Neither Medicare nor TRICARE will cover your claims. You will be responsible for paying the provider. You can file an appeal over Medicare’s decision. If Medicare decides to cover your charges, TFL will also reconsider your claims.
*If the care is medically necessary, but you have exhausted your Medicare benefits: TRICARE becomes the primary payor. In the event that TRICARE covers your claims, you will be responsible for the TFL deductible and cost-share.

What Happens If a Provider Opts out of Medicare?

Some providers do choose to opt-out of accepting Medicare. That prevents them from billing Medicare, meaning they bill you for charges related to your medical care. Medicare covers nothing from opt-out providers. TRICARE is the second payor unless you have OHI.

TRICARE covers up to 20 percent of allowed TRICARE amounts for services. You will be responsible for any remaining billed charges. The rule applies to any care received from a U.S. Department of Veterans Affairs (VA) for injuries or illnesses not related to your military service. Read more about the VA and associated care and costs at www.va.gov/healthbenefits/apply/veterans.asp.

What if Tricare Does Not Cover Medicare-Eligible Services?

For services like chiropractic care that only Medicare covers, they will process their portion of any claim, while TCL will contribute nothing. You will be responsible for paying the Medicare deductible and cost-shares.

What If Medicare Does Not Cover TRICARE for Life-Eligible Services?

When you receive care like TRICARE-eligible services received overseas, Medicare contributes nothing towards paying your claims. You will be responsible for paying TFL’s deductible and cost-shares along with the balance of any bills from providers.

Be prepared to pay costs up-front for any overseas care. You will need to file a claim with TRICARE to receive reimbursement.

What If Neither TRICARE for Life nor Medicare Cover My Services?

You will be responsible for charges for all services received from your provider(s).

How Would TRICARE for Life Work with Other Health Insurance?

Your OHI would typically be responsible for processing and paying claims before sending it to TFL. The order of how Medicare and your OHI handle medical claims depends on whether you have insurance through your current employer.

Other factors that contribute to your claim payment include whether you were outside of the U.S. when receiving care. While your OHI and TRICARE might cover overseas services, Medicare does not cover any care received outside of the U.S., any of its territories (American Samoa, Guam, the Northern Marina Islands, Puerto Rico and the U.S. Virgin Islands), or aboard ships stationed outside of U.S. territorial waters.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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