Beneficiaries eligible for both TRICARE and Medicare should understand how the two medical insurance programs work together. Medicare consists of a few different parts. If you’re familiar with these parts, you might be wondering how each works with TRICARE, and if additional supplemental insurance is necessary for those who are dual-enrolled in both Original Medicare and TRICARE.
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TRICARE For Life (TFL) is the health insurance program available to U.S. military retirees who qualify, as well as their beneficiaries, for no cost. It’s different and separate from Medicare. Medicare is the U.S. national health insurance program for individuals 65 years of age and older or who are disabled. It’s crucial for those who are dual-eligible to understand their coverage options.
How Does TRICARE For Life Work with Original Medicare?
TRICARE-eligible beneficiaries will be automatically enrolled in TRICARE For Life when they sign up for both Part A and Part B. This means you don’t need to worry about enrollment forms.
You must pay your monthly Part B premium to remain enrolled. If you enroll in both Medicare and TFL, Medicare will be your primary insurance, and TFL will work as a wraparound.
TFL will help cover costs for which the beneficiary would otherwise be responsible to pay. This includes the Part A hospital deductible and Part B coinsurance.
When used together, TFL and Medicare will cover most procedures deemed medically necessary. It’s also important to know that TRICARE doesn’t issue insurance cards, unlike Medicare which issues its red, white, and blue card.
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Some TRICARE For Life beneficiaries choose to enroll in Medicare Advantage plans (Medicare Part C) to access benefits such as gym memberships and dental, vision, and hearing coverage. As Medicare doesn’t cover these benefits, an Advantage plan is a means for the beneficiary to obtain them. Before you enroll in a Medicare Advantage plan, make sure your health care providers are in the plan network – meaning they accept your coverage.
For example, if you have a Medicare Advantage HMO plan and TFL, the HMO is your primary insurance, and TFL acts as a supplement. If you receive care outside your HMO network, the HMO won’t cover any of the costs. Any claim will be forwarded to TFL.
Anything the Advantage plan doesn’t cover, TFL will help to cover. This includes copays and deductibles, for which you would be otherwise responsible.
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Therefore, if your providers are in your network, you may ultimately have no out-of-pocket expenses once TFL has paid its share. Thus, underscoring the importance of ensuring your providers are in-network before signing up for a Medicare Advantage plan.
How Does TRICARE For Life Work with Part D?
If you are a TRICARE For Life beneficiary, there is generally no need to enroll in a Medicare Part D prescription drug plan under Medicare. TRICARE For Life includes prescription drug coverage, for which there is no additional charge to you.
Prescriptions for maintenance drugs, such as medications for blood pressure or cholesterol, must be filled through TRICARE’s mail order pharmacy. Acute care prescriptions for TRICARE For Life beneficiaries are available at their local pharmacy or military base. In both scenarios, TRICARE For Life pays for the prescriptions, and the beneficiary is usually responsible for a copay.
If you have TRICARE For Life and later decide to enroll in Part D, you won’t have to worry about being penalized. The late enrollment penalty you might otherwise have to pay for Part D gets waived because TRICARE drug coverage qualifies as creditable coverage.
If you have limited income and resources, you could qualify for Extra Help paying for a Part D prescription drug plan.
How Does TRICARE For Life Work with Medigap?
TRICARE For Life acts similar to a Medicare Supplement plan. It’s possible to also enroll in a Medicare Supplement plan if you have both TFL and Medicare.
Whether this would be advantageous to you is dependent on your health insurance needs. If you enroll in Medicare, TFL, and Medigap, Medicare will be your primary insurance, the Medicare Supplement plan will be secondary insurance, and TFL will pay last.
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How Does TRICARE Prime Work with Medicare?
If you’re under the age of 65 when you have Medicare with TRICARE Prime, you don’t need to disenroll. TFL isn’t mandatory.
Those on Medicare because of disability can remain on TRICARE Prime as long as they’re eligible. When you qualify, you’ll get a waiver for Prime enrollment fees or a refund for a past enrollment fee.
MilConnect lets TRICARE beneficiaries save and print an eligibility letter for Proof of Insurance. This information allows you to show creditable coverage for any other insurance you may purchase in the future. This information is available online or through a written request.
How Does TRICARE Plus Work with Medicare?
TRICARE Plus is a primary care program that allows beneficiaries to get primary care appointments at military hospitals and clinics. Each hospital or clinic decides if it accepts TRICARE Plus. You must enroll to participate, but your enrollment is based on where you originally enrolled.
When it comes to benefits, TRICARE Plus offers the same primary care access as TRICARE Prime. It works the same as regular TRICARE in regards to Medicare because it’s still primary coverage. The military clinic or hospital doesn’t cover costs for beneficiaries who receive care from non-military health facilities.
Before scheduling any appointments, beneficiaries should contact their local military hospitals to make sure they accept TRICARE Plus. TRICARE Plus is available for TRICARE-eligible individuals who aren’t enrolled in TRICARE Prime.
Notice of Award or Disapproved Claim
In most cases, you need to take your Notice of Award to the Social Security office, or local ID card office to update your information in the Defense Enrollment Eligibility Reporting System (DEERS) records. When information is incorrect in the database, this causes problems with your health care benefits.
Marital Status and TRICARE Eligibility
The below information details how your marital status affects your eligibility for TRICARE and Medicare.
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Single/never married: You continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.
Widow(er): If you’re eligible for premium-free Part A, you should also sign up for Part B. Your TRICARE For Life coverage begins on the date you have both Parts A and B. If you’re not eligible for premium-free Part A, you continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.
Married/divorced (spouse age 62 or older): If you’re eligible for premium-free Part A, sign up for Part B as well. Your TRICARE For Life coverage begins on the first day you have both Parts A and B. If you aren’t eligible to receive premium-free Part A under your spouse’s (or former spouse’s) Social Security number, you continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.
Married/divorced (spouse younger than age 62): You continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday. Three months before your spouse (or former spouse) turns 62, apply for Medicare Part A under their Social Security number.
How Does US Family Health Plan Work with Medicare?
The US Family Health Plan offers the TRICARE Prime benefit to eligible military beneficiaries. As of October 1, 2012, Medicare-eligible individuals over age 65 cannot enroll in the US Family Health Plan. However, if your US Family Health Plan coverage began before September 2012 with no break, you can keep it when you age into Medicare.
TRICARE recommends also enrolling in Medicare Part B to avoid the late enrollment penalty. Medicare-eligible individuals under 65 can still stay on the US Family Health plan until aging out and transitioning to TFL. Those over 65 who are ineligible for Part A based on work credits can also still enroll in USFHP.
FAQs
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I just turned 65 and have Medicare, if I understand it correct it is the primary insurance, tricare becomes secondary so do I have to get a referral to go to a specialist
Donna,
Great question! Medicare does cover Remicade Infusions under Medicare Part B when administered by a physician.
If I have Medicare Part A and B plusTRICARE for life do I need a Medicare supplement as well or will the Medicare and TRICARE give me adequate coverage? I
Erika, this depends on your personal needs. TRICARE acts as a supplement to Part A and B but the coverage is different from traditional Medigap plans. I recommend speaking with your VA plan administrator to review your Tricare coverage then compare that to a Medigap plan to see which makes the most sense for you.
I have Medicare parts A & B plus USFHP. What should I do to add dental and vision. I already get prescription coverage.
Hi Barbara – ancillary plans are available for dental, vision, and hearing coverage. You can add these to your existing coverage.
Hi , I am a veteran of the Air Force reserve, 6 months active duty 6 1/2 years reserves. I am 83 years old ang have been purchasing a Medicare supplement for years for about $200 per month. My prescription costs always puts me in the gap. Could tri care for life be of benefit to me and my wife?
Hi Vincent! If you’re eligible for TRICARE for Life, then that in addition to Part A & Part B of Original Medicare will give you great coverage. You wouldn’t need Medigap at that point. Medigap does not cover prescription drugs, TRICARE does. I would recommend reaching out to a representative at the VAs office for assistance.
I’m being forced to enroll in tricare plus as I am being dropped from tricare prime on the first of Jul 2021. what impact does tricare plus have on tfl? tks
When I begin my Medicare coverage, will TRICARE automatically quit charging me their monthly fee?
Hi Lindsay, my husband is 100% VA disabled due to ESRD and is under 65, he just got the letter from medicare that he is eligible. I’m wondering how will it effect mine and our 6 year old son’s Tricare select coverage?
Hi Yvonne! I do not believe it should impact you or your son’s TRICARE coverage since your husband will still have TRICARE. I would reach out to his benefits administrator to verify though.
How does Medicare, TFL and 60% military disability work together? Currently use VA and everything is covered at NO cost.
Once I need to get Medicare (and probably TFL), will I need to change from VA care and use other facilities? Do I really need TFL since everything is already covered? Why pay part B premium when I don’t need it??
Hi Julie! Once you get Medicare, TRICARE beneficiaries are automatically enrolled in TRICARE for Life. No, you don’t need to use another facility. Having both Medicare & TFL gives you the option to see both VA facilities and non-VA facilities. You’ll pay nothing out of pocket for services covered by both Medicare and TRICARE. If you don’t want to be restricted to VA facilities, then you want Part B. You also want to get Part B when you’re first eligible because TRICARE is NOT considered creditable coverage. If you go to enroll in Part B later for one reason or another, you will have to pay a penalty for the rest of your life.
Getting older turning 65 in Jan 22. I current have Tricare for myself and my wife. Just looking for basic information and to get pointed in the right directions for our future. Any suggestions?
Thanks Robin
Hi Robin! Once you turn 65 and enroll in Part A & Part B, you will automatically be enrolled in TRICARE for Life. Medicare is primary, TFL is secondary. You MUST be enrolled in Part A & Part B to keep TRICARE. You will have great coverage with TRICARE for Life & Medicare combined. You can find out more information on the TRICARE website.
I’m under 65 but on Medicare, with Tricare after being medically retired.
It’s been extremely difficult to get any clear answers about the difference between benefits. Sometimes providers call and say Tricare is charging me under the POS option from Tricare prime, but most of the time it is paid under TFL with no problems. I’ve tried researching but am unable to find any clear answers on benefit of keeping prime vs TFL.
Hi Steven! When you have TRICARE Prime or receive coverage through TRICARE for Life, your claims don’t process through the regional contractor. The provider files the claim with Medicare first, then Medicare pays their portion and sends the balance to TRICARE for Life contractor. You can find more information on this on TRICAREs website.
I’m getting confusing information. I turn 65 in May and currently have healthcare coverage with my employer. I’m also a Military Retiree so I have Tricare select. I enrolled in Medicare part A, but I’m wondering if I still need to enroll in Part B to keep my eligibility for Tricare for Life?
Hi Carl! Yes, you must enroll in both Part A & Part B to be eligible for TRICARE for Life if you’re not on active duty.