The TRICARE For Life (TFL) program provides additional coverage for TRICARE beneficiaries who also have Medicare Part A and Part B, regardless of where they live or their age. This program is for military retirees and their dependents, and serves as a supplement to Medicare. TFL provides comprehensive health care coverage, including coverage for prescription drugs as part of the TRICARE Pharmacy Program.
Who is eligible?
To be eligible for TFL, beneficiaries must prove their eligibility for TRICARE in the Defense Enrollment Eligibility Reporting System (DEERS). For this reason, it is important for anyone enrolled in TRICARE to ensure that their information is kept current in DEERS. Doing so will ensure that TFL benefits are delivered effectively and quickly.
An individual must also be eligible for Medicare to be eligible for TFL. Medicare is a federal health insurance that provides:
- Hospital insurance (Medicare Part A)
- Medical insurance (Medicare Part B)
The following groups are eligible for Medicare:
- Those who are 65 or older
- Individuals who are under the age of 65 with certain disabilities
- Individuals of any age who have end-stage renal disease
The following groups are eligible to receive TFL coverage:
- Uniformed Service retirees, including Reserve or National Guard members receiving retired pay
- Medicare-eligible widows and widowers
- Medicare-eligible family members
- Some former spouses
- Individuals who are entitled to Medicare Part A due to disability or chronic renal disease
What are the benefits?
TFL coverage is available around the world, and beneficiaries can see any provider they choose. However, beneficiaries who receive care from Veteran’s Administration providers, or providers who opt-out of Medicare, will pay more out of pocket since these providers are not allowed to bill Medicare.
Medicare is only available within the United States, so for those beneficiaries living in U.S. Territories or other overseas areas, TFL is the primary payer for health care. Generally, overseas coverage for TFL is the same as TRICARE Select Overseas, and the cost-shares and deductibles are the same.
Individuals enrolled in any TRICARE plan are automatically enrolled in one of two pharmacy programs:
- Tricare Pharmacy Program: Provides necessary prescription medications to beneficiaries in an easy and cost-effective way
- Tricare Maintenance Medications Program: Any beneficiaries who take select maintenance medications must receive refills through TRICARE Pharmacy Home Delivery, or use a military pharmacy. Individuals with this plan cannot refill prescriptions at retail pharmacies
How much does TFL cost?
There are no fees for enrolling in TFL; however, beneficiaries must pay monthly premiums for Medicare Part B. This premium is based on income, and can vary based on several factors:
- Beneficiaries do not pay out of pocket for services that are covered by both TRICARE and Medicare
- In the United States and U.S. Territories, TRICARE coverage pays after Medicare
- In other overseas areas, TRICARE is the first payer for medical costs
- If individuals receive benefits from Social Security, the Office of Personnel Management, or the Railroad Retirement Board, their Part B premium will be deducted from the benefit payment
- Individuals who do not receive these benefits will receive a bill for their Part B premium
- Most people in Medicare Part B will pay a standard amount for their premium, but those who have modified gross adjusted incomes above a certain amount may have to pay an Income Related Monthly Adjustment Amount
In 2020, the standard amount for a Part B premium is $144.60.
TFL serves as secondary insurance coverage for Medicare. For covered services, Medicare pays 80 percent, and TFL pays the remaining 20 percent and the Medicare deductible. For services that are covered by Medicare but not TRICARE, Medicare covers 80 percent, and the TFL beneficiary is responsible for the other 20 percent.
TFL beneficiaries can visit any authorized provider for care. Beneficiaries can receive care at military clinics and hospitals if there is space available. After the appointment:
- The provider files the claim with Medicare
- Medicare pays its portion, and then sends the claim to TFL claims to be processed
- TFL pays the provider directly for services covered by TRICARE
- For proof of coverage, beneficiaries need their Medicare card and military ID
There are two TFL contractors that help beneficiaries with claims, and provide customer service to all those using the program. These include:
- Wisconsin Physicians Service: Serves beneficiaries in the United States and U. S. Territories
- International SOS: Serves all other areas overseas
How do beneficiaries enroll?
If an individual is already eligible for TRICARE, is entitled to Medicare Part A, and has Medicare Part B, they are covered under TFL. There is no paperwork to be completed, enrollment forms that must be submitted, or enrollment fees. TFL coverage begins the day an individual has both Medicare Part A and Medicare Part B; in order to remain eligible for TFL benefits, individuals must continue to pay Medicare Part B premiums, and remain eligible for TRICARE.
It is possible for other family members to enroll in TFL coverage, as long as they are eligible for Medicare. Due to the fact that TFL is an individual entitlement, families are not automatically covered.
A person’s birth date determines when they become eligible for Medicare. If their birthday is on the first day of the month, they are eligible for Medicare on the first day of the month before they turn 65. If their birthday is after the first day of the month, they become eligible for Medicare on the first day of the month that they turn 65.
For those with additional insurance
For individuals with additional insurance beyond TFL and Medicare, like an employer-sponsored health plan, TRICARE pays after Medicare and other health insurance. After the other health insurance plan processes a claim, beneficiaries must file a paper claim with their TFL contractor. The claim should include:
- Provider’s itemized bill
- Explanation of benefits from other health insurance plans
- Medicare Summary Notice
The TFL contractor will process the claim and pay TRICARE’s portion to the beneficiary. Claims must be filed within one year from the date care was provided.
Heather Maxey works at a non-profit that addresses military ineligibility. She is an Army spouse, and met her husband while working as a Health Educator at Fort Bragg.
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