TRICARE for Life is a great benefit for many veterans and their spouses, but understanding how it works can be difficult. Find out how TRICARE for Life and Medicare work together to cover your healthcare needs.
Is TRICARE Medicare?
No, these are two distinct health programs. The Department of Defense oversees TRICARE. In contrast, the Center for Medicare and Medicaid, often referred to as CMS, manages Medicare.
What is TRICARE for Life, and Who’s Eligible?
TRICARE for Life, sometimes called TFL, is wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and Part B. Medicare and TRICARE for Life coverage work together to help pay medical bills for retired and active-duty military personnel and families.
How Do I Apply for TRICARE for Life?
Medicare- and TRICARE- eligible individuals enjoy automatic enrollment, so long as they are also enrolled in Original Medicare Part A and Part B and pay their Part B premiums. You must have both Medicare Part A and Part B to qualify for TRICARE for Life.
Do You Have Access to TRICARE for Life Outside the United States?
TRICARE pays after Medicare in the United States and in U.S. territories. Medicare generally doesn’t offer coverage outside the U.S. and U.S. territories. In this case, TRICARE pays first.
Medicare does make these three rare exceptions to foreign coverage:
- You live within the United States, but the closest hospital that can handle your medical emergency lies outside the United States.
- You live within the United States, but the closest hospital that can treat your health condition lies outside the United States.
- You’re traveling through Canada to move between Alaska and another U.S. state, and you need to stop at a Canadian hospital to treat an illness or injury without an unreasonable delay. Medicare determines the definition of an unreasonable delay for each case.
Note that Medicare only pays for approved services within the foreign hospital under these circumstances.
Which Providers Can You Visit with TRICARE for Life?
To avoid potential high out-of-pocket costs, you should seek providers that accept both Medicare and TFL. You also have access to military health facilities but only on a space-available basis.
If you visit a provider who has opted out of Medicare, TRICARE will generally only pick up its portion of the claim as a secondary payer, leaving you with substantial out-of-pocket costs. In underserved areas, TRICARE may make an exception and serve as the primary payer.
How Do TRICARE for Life and Medicare Process Claims?
Typically, your provider will file claims with Medicare first. After Medicare calculates its share, it will forward the claim information to TFL.
If you have other health insurance, Medicare will submit claims to that insurance company first. Afterwards, you can send a claim to TFL for any outstanding amount not covered by Medicare or the other insurer. For instance, if you also have a Medicare Supplement and TFL, Medicare would pay first, and the supplement would pay second. Afterwards, TFL would pay remaining, eligible expenses.
What Happens if a Provider Opts Out of Medicare?
If your provider opts out of Medicare, Medicare will pay nothing. TFL would cover up to 20 percent of allowed TRICARE amounts for services, and you’d be responsible for the remaining bill. This 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. You can read more about the VA and associated care and costs at www.va.gov/healthbenefits/apply/veterans.asp.
What if Tricare Doesn’t Cover Medicare-Eligible Services?
For services that only Medicare covers, like chiropractic care, they will process their portion of the claim. TFL will contribute nothing, and you’ll be responsible for paying the rest of the bill.
What If Medicare Doesn’t Cover TRICARE for Life-Eligible Services?
When you receive TRICARE-eligible services overseas, Medicare won’t contribute anything towards paying your claims. You’ll be responsible for paying TFL’s deductible and cost-shares along with the balance of any bills from providers, and you’ll need to file a claim with TRICARE to receive reimbursement.
Is Medicare and TRICARE for Life Enough Coverage?
Many people who receive Medicare and TRICARE for Life find that they don’t need additional medical coverage. However, you do have the option of picking up a Medicare Supplement or Medicare Advantage plan.
TRICARE for Life and Medicare Advantage plans
Medicare Advantage plans can offer attractive benefits like dental coverage. Unfortunately, because an Advantage plan would act as your primary coverage, you’d also have to deal with its limitations. While TFL may help you with the typically high out-of-pocket costs, you’ll need to receive your services from the Advantage carrier’s network of doctors.
TRICARE for Life and Medicare Supplement plans
Medicare Supplements won’t impact your TFL coverage. These plans act secondary to Medicare, and allow you to visit any provider that accepts Medicare, even if they don’t accept TRICARE. Medicare Supplements are available in a variety of standardized plans, so you can receive healthcare across the country and know what to expect.
Does TRICARE Cover Silver Sneakers?
SilverSneakers provides access to fitness clubs, and isn’t offered by either Medicare or TRICARE. You can decide to enroll in a Medicare Supplement or Advantage plan for perks like SilverSneakers, but you should consider the effect that it may have on your health coverage.
Understanding the ins and outs of TRICARE and Medicare can be difficult. If you’re ever in doubt, you can reach out to your provider or a TRICARE representative for assistance.
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.