What Is TRICARE For Life and How Does It Work With Medicare?

TRICARE For Life is a health benefit program for uniformed service members and their families. It works in conjunction with Medicare, the federal health insurance program for individuals generally aged 65 or older, and those with certain disabilities. TRICARE For Life functions as supplemental coverage, enhancing the benefits provided by Medicare. It aims to reduce out-of-pocket healthcare costs for eligible beneficiaries.

Eligibility for TRICARE For Life

To qualify for TRICARE For Life (TFL), individuals must meet specific TRICARE eligibility and Medicare enrollment criteria. They must first be a TRICARE beneficiary, which includes retired Uniformed Service members, retired Guard or Reserve members at age 60, and their eligible family members. Eligibility also extends to Medal of Honor recipients and their families. Their information must be current and accurate within the Defense Enrollment Eligibility Reporting System (DEERS).

Individuals must also be eligible for and enrolled in both Medicare Part A and Medicare Part B. Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. Most people qualify for premium-free Medicare Part A if they or their spouse paid Medicare taxes through employment for at least 10 years.

Medicare Part B covers medical services, including doctor visits, outpatient care, durable medical equipment, and some preventive services. Enrollment in Medicare Part B requires a monthly premium payment. If a TRICARE beneficiary is eligible for premium-free Medicare Part A, they must enroll in Medicare Part B to maintain TRICARE eligibility. Declining Medicare Part B coverage or failing to pay its premiums results in a loss of TRICARE benefits.

How TRICARE For Life Works with Medicare

TRICARE For Life operates on a coordination of benefits model, where Medicare serves as the primary payer and TRICARE For Life acts as the secondary payer. When a healthcare service is covered by both Medicare and TRICARE For Life, Medicare processes the claim first and pays its authorized portion. The claim is then sent to the TRICARE For Life claims processor, which pays for TRICARE-covered services. This coordination often results in minimal or no out-of-pocket costs for services covered by both programs.

TRICARE For Life helps cover costs such as Medicare deductibles, copayments, and coinsurance that would otherwise be the beneficiary’s responsibility. If Medicare covers a service, TFL may pay the remaining balance after Medicare’s payment, provided the service is also covered by TRICARE. This supplemental coverage helps to reduce the financial burden on beneficiaries.

TRICARE For Life acts as the primary payer when healthcare is received overseas, as Medicare does not provide coverage outside the United States. In such cases, TFL covers the care, and beneficiaries may be subject to TRICARE’s annual deductible and cost-shares.

TRICARE For Life may also cover certain services that Medicare does not, such as specific types of care or prescription drugs. For services covered only by TRICARE and not Medicare, beneficiaries pay any applicable TRICARE deductibles and cost-shares. If a service is covered by Medicare but not TRICARE, individuals are responsible for Medicare’s deductibles and cost-shares.

Understanding TRICARE For Life Costs

TRICARE For Life does not impose enrollment fees or monthly premiums for eligible beneficiaries. However, a significant cost associated with maintaining TRICARE For Life coverage is the mandatory payment of Medicare Part B monthly premiums. These Part B premiums are determined by an individual’s income, with higher incomes resulting in higher premiums. For many, these premiums are automatically deducted from their Social Security or Railroad Retirement Board benefits.

Beneficiaries may still incur some out-of-pocket expenses. These costs arise for services not covered by both Medicare and TRICARE, or for which specific copayments or deductibles apply. If a service is covered by TRICARE but not Medicare, beneficiaries pay the TRICARE For Life deductible and cost-shares. Services not covered by either program, such as cosmetic surgery, are the full responsibility of the beneficiary.

TRICARE For Life includes prescription drug coverage, so beneficiaries do not need to enroll in a Medicare Part D prescription drug plan. This integrated pharmacy benefit helps manage medication costs. For services covered by both Medicare and TRICARE For Life, out-of-pocket expenses are usually eliminated. The program also features a catastrophic cap, which limits the maximum amount a beneficiary will pay out-of-pocket for covered services within a calendar year.

Enrolling in TRICARE For Life

Enrollment in TRICARE For Life is largely an automatic process once beneficiaries meet the necessary criteria. Coverage automatically begins on the first day an individual has both Medicare Part A and Medicare Part B in effect. There are no specific enrollment forms or fees required for TRICARE For Life itself. The Defense Manpower Data Center, which manages DEERS, receives Medicare eligibility data directly from the Centers for Medicare & Medicaid Services, facilitating this automatic coverage.

Beneficiaries must ensure their information is up-to-date in the Defense Enrollment Eligibility Reporting System (DEERS). While TRICARE For Life enrollment is automatic, beneficiaries must proactively sign up for Medicare Parts A and B through the Social Security Administration (SSA).

To avoid gaps in TRICARE coverage, enroll in Medicare Part A and Part B at least two to four months before turning age 65. Delayed Medicare Part B enrollment can lead to a break in TRICARE coverage and a late enrollment penalty, resulting in higher monthly premiums. Active duty service members and their families may delay Medicare Part B enrollment without penalty until the active duty sponsor retires. Once Medicare Part A and Part B are active and reflected in DEERS, TRICARE For Life coverage will be in place.