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Understanding How Tricare for Life and Medicare Work Together

  • TRICARE for Life is an extended health insurance policy for Medicare-eligible uniformed service personnel and their families.
  • The policy often helps reduce out-of-pocket costs that come with healthcare.
  • If you have Medicare Part A and Part B and meet certain eligibility criteria, you can qualify for TRICARE for Life.

TRICARE for Life acts almost like a Medicare supplement plan for Medicare-eligible military personnel and their family. The plan can help cover some copayments and deductibles for Medicare, as well as prescription drugs.

If you qualify, TRICARE for Life benefits can significantly reduce your out-of-pocket costs.

Keep reading to find out how TRICARE for Life works with Medicare (including Medicare Advantage) to provide coverage for your healthcare needs.

TRICARE for Life is an insurance program that provides expanded healthcare coverage for active duty and retired uniformed service members who are ages 65 or older and eligible for Medicare.

These benefits may also extend to those related to the service members, including:

  • eligible family members
  • eligible survivors
  • former spouses (must meet certain qualifications)
  • Medal of Honor recipients and their families
  • those registered in the Defense Enrollment Eligibility Reporting System (DEERS)

Your benefits may vary based on the beneficiary category you belong to.

TRICARE for Life is referred to as “wraparound” coverage. The policy is intended to provide additional health benefits to those who have served in the U.S. military, as well as their families.

This coverage type also extends to care received overseas, which Medicare doesn’t cover.

Eligibility criteria

To receive TRICARE for Life benefits, you must be enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Together, these parts are known as original Medicare.

You should automatically qualify for Medicare benefits when you turn age 65.

The Social Security Administration (SSA) will automatically enroll you if you currently receive benefits. If you don’t, you can sign up with the SSA by calling 800-772-1213 or visiting your local SSA office.

Once you have Medicare parts A and B, you are automatically enrolled in TRICARE for Life, provided your information is up to date with DEERS. There is no enrollment fee.

If you have beneficiaries that are younger than age 65 and don’t yet qualify for Medicare, they aren’t personally eligible for TRICARE for Life (yet). There are other TRICARE policies for those younger than age 65 who don’t qualify for Medicare.

TRICARE for Life is intended to help reduce your out-of-pocket costs when you are eligible for Medicare. It also provides overseas benefits, which can be helpful if you frequently travel out of the country.

Generally, Medicare will pay first for services, then TRICARE for Life will pay any remaining costs. However, there may be some exceptions.

Here are a few examples:

  • If you see a provider who opts out of Medicare, TRICARE will pay for a portion (unless you have other health insurance) as if Medicare had paid for the charge. You’ll pay any remaining costs.
  • If you receive a service from Medicare that TRICARE doesn’t cover (such as chiropractic care), you’re responsible for the Medicare-approved amount.

TRICARE for Life also has its own medication formulary list, similar in some ways to Medicare Part D. TRICARE offers a formulary search tool that can help you find out your medications are covered and how much they’ll cost.

Medicare requires you to have some form of prescription drug coverage. TRICARE for Life qualifies as creditable prescription drug coverage, so you don’t have to purchase a separate Part D plan.

However, you can still choose to purchase a Part D plan, as it may cover more drugs and may have fewer rules than with TRICARE. For example, TRICARE for Life may not cover drugs from your preferred retail pharmacy or prescriptions from a non–Veteran’s Administration (VA) provider.

If you need help paying for prescription drugs, you can apply for Medicare Part D’s Extra Help assistance program through the SSA’s website.

What about Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is an alternative to traditional Medicare.

By choosing this option, you can sign up for Medicare benefits through a private insurance company. The insurance company must cover all the same benefits as traditional Medicare, and many plans offer additional services.

These extras may include prescription drug, vision, dental, and hearing coverage, depending on the policy.

When you have TRICARE for Life, you can certainly choose a Medicare Advantage policy. However, it’s important to know how having both policies may impact you. These considerations include:

  • Prescription drug coverage. TRICARE for Life offers prescription drug coverage. So do many Medicare Advantage plans. If you don’t want dual coverage, you may choose a Medicare Advantage plan that doesn’t offer prescription drug benefits, which will likely make the monthly premium cheaper.
  • Provider networks. You’ll usually experience the greatest cost-savings in Medicare Advantage if you use in-network providers. This is usually a smaller network than you would have with original Medicare or TRICARE for Life.
  • Costs. Some Medicare Advantage plans are premium-free, others are not. Most plans will require you to pay a copayment when you see in-network doctors. Often, TRICARE for Life will pay the costs of these copayments.

The answer to this question depends if you are or aren’t on active duty. We’ll explain the details of both situations next.

If you’re on active duty

TRICARE will pay first for Medicare-covered services if you’re on active duty. If TRICARE and Medicare cover the service, TRICARE will pay the Medicare deductible and coinsurance (if any). TRICARE will also pay for any services that it covers but Medicare does not.

If you’re not on active duty

As a general rule, Medicare will be the primary payer or the policy that pays first for all Medicare-approved services from non-VA providers. Medicare will pay up to its defined coverage limits.

TRICARE will usually act as the secondary payer. If there are costs remaining that TRICARE covers, TRICARE will help pay for them. Having both forms of insurance can significantly reduce your out-of-pocket costs. It’s important to know that just because TRICARE pays for some of the costs Medicare doesn’t cover, it may not pay for all of them.

An exception is when you receive care from a military hospital or any other federal healthcare provider. TRICARE will usually be the primary payer for these services.

How to get your questions answered

If at any time you have questions about who pays for what, you can call Medicare’s Benefits Coordination & Recovery Center at 855-798-2627 (TTY: 855-787-2627). You can also call TRICARE for Life at 866-773-0404.

Often, choosing the policy that works best for you is a matter of deciding the services you want or need. TRICARE for Life can significantly reduce your out-of-pocket costs but still may not cover some of the services that Medicare Advantage does.

You can also purchase additional policies, such as Medicare supplement insurance (Medigap) or Medicare Part D plans through private insurance companies. All of these may help reduce your overall healthcare costs.

Tips for selecting plans that meet your needs

  • Assess your current and potential healthcare needs. Are there doctors, facilities, or medications that you can’t compromise on for your care? This may impact your policy choice, particularly when deciding between original Medicare and Medicare Advantage.
  • Consider your income. If you have a fixed or limited income, paying monthly premiums may be difficult. However, if you may need care that only Medicare Advantage would cover, this might be your best bet for cost savings in the long run.
  • Look for cost-savings programs. You may qualify for certain programs to help with your costs, including Medicaid and Extra Help.
  • Find the right plan. Use the Medicare plan comparison tool to compare available Medicare Advantage plans in your area. You can search by prescription drugs you need, as well as covered providers and services.

Healthline

  • TRICARE for Life helps supplement coverage for Medicare costs by (usually) acting as a second payer.
  • TRICARE for Life acts as the first payer for federal healthcare and medically necessary care you receive overseas.
  • For more information on TRICARE for Life, you can call 866-773-0404 or visit their website here.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

Healthline

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