5 Things Veterans Should Know About Using TRICARE For Life With Medicare
Key takeaways:
TRICARE is federal health insurance for active duty and retired U.S. service personnel and their family members. There are many different TRICARE programs.
TRICARE for Life (TFL) is supplemental insurance for military retirees and their dependents who are eligible for Medicare. TFL picks up Medicare’s out-of-pocket costs, such as deductibles and copayments, without an additional premium for TFL coverage.
You must have Medicare Part A and Part B to remain eligible for TFL.
You will pay nothing out of pocket for services covered by both Medicare and TRICARE for Life.
Table of contents
TRICARE is federal health insurance that provides comprehensive coverage for millions of active duty and retired U.S. service members and their relatives across the globe. There are several different TRICARE programs.
One of them is TRICARE for Life (TFL), which is supplemental insurance for service members and dependents who are eligible for both TRICARE and Medicare. Most people are eligible for Medicare at age 65. In most cases, you will need to have Medicare Part A and Part B to qualify for TFL.
TFL is a wraparound supplement that covers out-of-pocket Medicare costs — such as deductibles, copayments, and coinsurance — which could bring you significant savings. In many ways, TFL works like a Medigap plan.
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See what other benefits you qualify for—from cashback cards to cheaper insurance.
In this article, we’ll cover five things you should know about how TRICARE for Life and Medicare work together.
1. TRICARE for Life works with Medicare to reduce your costs and increase your coverage
Qualifying for both TRICARE for Life and Medicare means almost all of your care can be covered without any out-of-pocket costs if the services are covered by both Medicare and TFL.
TRICARE for Life covers “proven, medically necessary, and appropriate care,” and some care is not covered at all. For instance, dental care is not covered. Prescription drugs are covered under the general TRICARE pharmacy program. You can use this tool to find out what TRICARE covers.
Medicare has four parts:
Part A: Original Medicare’s hospital insurance
Part B: Original Medicare’s medical insurance
Part C: Medicare Advantage, a private insurance alternative to Parts A and B
Part D: Prescription drug coverage that can be added to original Medicare and may be included in or added to a Medicare Advantage plan; you probably won’t need this if you have TFL because you’ll still qualify for the TRICARE pharmacy program
For most people, Medicare Parts A and B plus TFL will provide better coverage and lower costs than Medicare Advantage (MA) plans. But, if you have an MA plan, TFL can reimburse you for copays on TRICARE-covered services when you file a paper claim.
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There are certain services that aren’t covered by TFL or Medicare. Some of them are:
Acupuncture
Experimental or investigational services (in most cases)
Routine eye exams
Hearing aids
It’s important to note that Medicare also has limits on the amount of covered care. In some cases, TFL may cover healthcare services after your Medicare benefits run out.
If you use Medigap or other health insurance and stack coverage, TFL pays last. TFL also requires preauthorization for certain services when it is the primary payer.
How are my out-of-pocket costs decided?
Whether a service is covered by Medicare, TFL, both, or neither will affect what you pay out of pocket. Here’s a chart with more details.
| Type of service | Medicare pays | TRICARE pays | You pay |
|---|---|---|---|
| TRICARE and Medicare | Medicare-authorized amount | Remaining amount | Nothing |
| Covered by Medicare only | Medicare-authorized amount | Nothing | Medicare deductible and cost-sharing, often 20% coinsurance |
| Covered by TRICARE only | Nothing | TRICARE-allowable amount | TRICARE deductible and cost-sharing (coinsurance) |
| Not covered by TRICARE or Medicare | Nothing | Nothing | Billed charges, which may exceed amounts allowed by TRICARE and Medicare |
How does my provider influence my out-of-pocket costs if I have Medicare and TRICARE for Life?
Your out-of-pocket costs can add up depending on where you receive care. You can choose a provider that participates in Medicare, one that doesn’t, or one that is not allowed to bill Medicare.
Depending on which you choose, here’s how your care will be paid:
Medicare participating providers accept the amount that Medicare allows as payment in full. You will have no out-of-pocket expenses.
Medicare non-participating providers can bill up to 15% over the Medicare-allowed amount, and TFL will cover this cost.
Opt-out providers cannot bill Medicare. TFL typically pays up to 20% of the Medicare-allowable charge and you’re responsible for the rest. In medically underserved areas (where medical care is limited), TFL may be the primary payer — which often lowers your out-of-pocket costs.
2. TRICARE for Life coverage starts automatically the first day you are covered by both Medicare A and B
TFL is generally available to military retirees and dependents. You only need Medicare Parts A and B to qualify for TFL. Coverage begins the first day you have Medicare Parts A and B. Just make sure you pay your Part B premium.
Spouses and former spouses of military retirees will become eligible once they qualify for Medicare.
3. TRICARE for Life can become a primary payer when you are living or traveling outside of the U.S.
TFL works with Medicare to line up payment for your healthcare depending on your provider. For instance, when you see a Medicare provider for a TRICARE-covered service, Medicare pays first, and then TFL pays all or most of the rest.
When you are outside the U.S. and U.S. territories, however, TRICARE for Life becomes the primary payer. So be prepared to pay TFL’s deductible and out-of-pocket costs.
It’s important to note that if you live overseas, you must still pay for Medicare Part B to remain eligible for TFL.
You also may be able to receive treatment at military hospitals and clinics or federal healthcare facilities if space is available.
4. You don’t have to pay additional premiums for TRICARE for Life
As long as you are enrolled in both Medicare Parts A and B (or a Medicare Advantage plan), you are automatically enrolled in TFL. TFL is free for eligible beneficiaries as long as you pay your Medicare B premiums. TFL does not issue a card. You only need to show providers your valid military ID.
Your main financial responsibility is to pay your Medicare Part B premiums. For people receiving Social Security, Part B premiums will be deducted from your benefits. Anyone not receiving Social Security will get a quarterly bill.
For most people, the 2023 Medicare Part B premium will be $164.90 per month. Premiums depend on income, so check here to see if your monthly payment will be higher.
5. Veterans Affairs care doesn’t mix with TRICARE for Life or Medicare
In short, Veterans Affairs (VA) care doesn’t work with Medicare. And, you’ll potentially have a big bill to pay if you’re depending on TFL to cover care at the VA.
Veterans Affairs cannot bill Medicare and Medicare doesn’t pay for VA services.
Be careful if you plan on using TFL coverage with a VA provider for care that’s not connected to your service. TFL can only pay up to 20% of the TRICARE-allowable amount. You may be responsible for the rest.
Where can I find help with how TFL and Medicare work together?
To find out if Medicare covers a specific service or benefit, visit www.medicare.gov or call 1-800-633-4227. If you have questions about Medicare and TRICARE eligibility, call the Defense Manpower Data Center Support Office (DMDCS) at 1-800-538-9552.
To find out if TFL covers the service or benefit, visit www.tricare.mil or call the Wisconsin Physicians Service—Military and Veterans Health at 1-866-773-0404. There’s also a TRICARE podcast series that has specific TFL episodes with additional information.
The bottom line
Military retirees and their dependents can greatly reduce out-of-pocket costs by using TRICARE for Life and Medicare when accessing services covered by both. That’s because Medicare pays first and TFL typically pays the rest. TFL coverage begins the first day you have both Medicare Part A and Part B.
Beyond what you pay for Medicare Part B, TFL coverage requires no additional premiums. TFL can become the primary payer when you’re living or traveling outside the U.S. or U.S. territories.
Be cautious when using Veterans Affairs providers because Medicare doesn’t pay for VA services and TFL may only pay 20% for care that’s not service-connected. You’ll be responsible for the rest.
Why trust our experts?
TRICARE and Medicare: Under Age 65. (2021). Brochure.
TRICARE For Life. (2021). Handbook.
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Tricare.mil. (n.d.). Health care.
Tricare.mil. (n.d.). TRICARE for life.
Tricare.mil. (n.d.). Using TRICARE for life overseas.
Tricare.mil. (n.d.). Using TRICARE for life with other health insurance.
Tricare Newsroom. (2022). Do you need all 4 parts of Medicare for TRICARE for life?. TRICARE Communications.
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