TRICARE For Life (TFL) is Medicare wraparound insurance for TRICARE beneficiaries who have both Parts A and B of Medicare regardless of age or place of residence. TFL offers complete medical insurance coverage. On a space-available basis, you have the choice to receive care from any Medicare-participating or non-participating provider, military hospital, or clinic. Your claims are submitted to Medicare by providers who participate in Medicare. Medicare automatically sends the claim to TRICARE for processing after paying its portion (unless you have other health insurance [OHI]). For medical services that are covered by TRICARE, OHI and Medicare are paid last.
TRICARE Eligibility Requirements
When you are eligible for Medicare Part A without a premium:
- You must maintain Medicare Part B coverage to continue to be eligible for TRICARE. If you are a,
- Retired service members (including National Guard and Reserve members who are receiving retirement pay);
- A family member of a retired service member;
- Medal of Honor recipient or eligible family member;
- Qualifying former spouse;
If you are an active duty service member (ADSM) or an active duty family member (ADFM), Medicare Part B coverage is not necessary to maintain your TRICARE eligibility. Adams and ADFMs continue to be eligible for TRICARE Prime, TRICARE Standard, and TRICARE Extra options while the sponsor is on active duty. However, you must have Medicare Part B in order to keep your TRICARE eligibility after the sponsor retires.
For details on the Medicare Part B special enrollment period for ADSMs and ADFMs, see “Medicare Part B [Medical Insurance]” on the following information
- You are covered by the US Family Health Plan, TRICARE Reserve Select (TRS), or TRICARE Retired Reserve (TRR) (USFHP) (Although you are not required to have Medicare Part B to continue to be eligible for TRS, TRR, or USFHP, it is highly recommended that you enroll in Medicare Part B when you are first eligible to avoid having to pay a premium surcharge if you enroll later.)
The Department of Defense oversees TFL. The Centers for Medicare & Medicaid Services oversees Medicare (CMS). To coordinate benefits, the two organizations collaborate.
Medicare is a government-run health insurance program that is available to everyone:
- 65 years or older
- Individuals under 65 with specific disabilities
- End-stage renal disease at any age (ESRD)
Medicare Part A (Hospital Insurance)
Medicare Part A encloses Hospice care, inpatient skilled nursing facility care, inpatient hospital care, and some home health care. Your eligibility for Medicare Part A is determined by the Social Security Administration (SSA) based on your employment history or the employment history of your spouse (including separated or deceased spouses). If you or your spouse have 40 quarters or 10 years of Social Security-covered employment, you are eligible for premium-free Medicare Part A at age 65.
Medicare Part B (Medical Insurance)
Medicare Part B encloses Provider services, outpatient care, home health care, durable medical equipment, and some preventive services. The monthly premium for Medicare Part B can change each year and is dependent on your income. For as long as you have Medicare Part B, you might be required to pay a monthly premium surcharge if you enroll after your initial enrollment period.
Medicare enables ADSMs and ADFMs to postpone Part B enrollment and enroll during a special enrollment period, which waives the late enrollment surcharge if they are eligible for Medicare due to age or disability (disability does not apply to those with ESRD). The ADSMs’ unique enrollment period and ADFMs is accessible whenever the or within eight years of active duty, the sponsor either (1) the month the end of your sponsor’s active duty, or (2) the final month of TRICARE coverage; whichever occurs initially. To prevent an intrusion Coverage under TRICARE, Adams, and ADFMs Medicare Part B enrollment is required prior to The active duty status of their sponsor expiring.
TRICARE for life with other health insurance
If you have any additional health coverage, such as Medicare or employer-sponsored insurance, in addition to TRICARE. You can use TRICARE For Life as long as you have both Medicare Parts A and B. TRICARE supplements do not count as “other health insurance,” such as a Medicare supplement or an employer-sponsored health plan. After Medicare and your other health insurance, TRICARE is the last to pay. To determine which plan pays first—Medicare or your other health insurance—visit the Medicare website.
You must submit a paper claim to Wisconsin Physicians Service, the TRICARE For Life contractor after your other health insurance has processed the claim (WPS). TRICARE’s portion of the claim will be processed by WPS and paid directly to you.