OCTOBER 2, 2024 – Are you approaching Medicare eligibility? Unlock your health by understanding how TRICARE For Life works with Medicare and plan your coverage effectively, while avoiding out-of-pocket costs.
“TRICARE For Life works with Medicare to minimize your out-of-pocket expenses for TRICARE-covered healthcare services you receive,” said Anne E. Breslin, TRICARE For Life Program Manager at the Defense Health Agency. “If Medicare and TRICARE both cover a healthcare service you receive, you won’t have to pay anything out of pocket.”
Here are some answers to common questions about TRICARE For Life and Medicare coverage.
Q: Who’s eligible for Medicare and TRICARE For Life?
A: Most people become eligible for Medicare the month they turn 65, but some may qualify earlier. If you receive Social Security disability benefits, or have certain health conditions, and are under 65, you may be eligible for Medicare.
It’s important to understand how entitlement to Medicare affects your TRICARE eligibility. Learn more in the TRICARE and Medicare Under Age 65 Brochure or the TRICARE and Medicare Turning Age 65 Brochure.
TFL is for military retirees and eligible family members who qualify for TRICARE and have both Medicare Part A and Part B, regardless of where you live. TFL is an individual benefit, meaning family members who aren’t eligible for Medicare can still be covered under TRICARE Prime or TRICARE Select.
Q: How do I get TRICARE For Life coverage?
A: TFL coverage begins the first day you have both Medicare Part A and Part B coverage. There are no forms or fees to enroll in TFL.
It’s important to avoid gaps in your TRICARE coverage by enrolling in Medicare Parts A and B at least two months before turning 65. You can enroll on the Social Security website or by contacting the Social Security Administration.
Check out the TRICARE For Life Handbook for more about signing up for Medicare.
Q: What are the different parts of Medicare and which ones do I need for TFL?
A: You need Medicare Part A and Medicare Part B to qualify for TFL.
Medicare Part A covers inpatient hospital care, skilled nursing, hospice, and some home health care. Most people qualify for premium-free Part A if they or their spouse worked and paid Social Security taxes for at least 10 years.
Medicare Part B covers outpatient care, durable medical equipment, and certain preventive services. There’s a monthly premium for Medicare Part B, which is based on your income.
You don’t need Medicare Part C or Part D to have TFL coverage, but there are some key details to know about these options.
Q: What should I know about Medicare Part C and Part D?
A: Medicare Part C (Medicare Advantage) is an optional plan provided by private companies that bundle Medicare Parts A and B. If you choose Medicare Part C, you may need to:
- Pay a monthly premium in addition to your Medicare Part B premium.
- Get healthcare services from the Medicare Advantage plan network of providers.
- Pay copayments at the time of service.
- File claims with TRICARE for any TRICARE-covered services.
Medicare Part D provides prescription coverage. It’s also optional. You don’t need Part D to be eligible for TRICARE Pharmacy benefits. If you have TFL, you remain eligible for the TRICARE Pharmacy Program. If you do choose to enroll in Part D, you’ll pay a monthly premium, and you must follow the plan’s rules for filling prescriptions.
Learn more about using Medicare Part D with TRICARE pharmacy benefits.
Remember: You won’t lose your TFL benefits if you sign up for a Medicare Advantage plan, but you will need to file your own claims with the TFL contractor, Wisconsin Physicians Service.
For dental and vision coverage, check to see if you qualify through the Federal Employees Dental and Vision Insurance Program.
Q: Does Medicare or TRICARE pay first?
A: When Medicare and TRICARE both cover a service, Medicare pays first, and TRICARE pays second. However, TRICARE covers some services that Medicare doesn’t. Check whether your care is covered by Medicare, TRICARE, or both, to avoid unexpected costs. Visit TRICARE’s covered services for details.
Q: What if I live overseas?
A: There are some differences to know. Medicare only covers care in the U.S. and U.S. territories, so if you live or travel overseas, TRICARE will become your primary payer. You’ll be responsible for paying TRICARE’s annual deductible and cost shares for overseas care. Use the TRICARE Compare Costs Tool to see your TFL costs.
Even though Medicare doesn’t provide coverage overseas, you must still have Medicare Part B to remain eligible for TRICARE.
Here’s what to keep in mind if you have TFL and live or travel overseas:
- You may visit any TRICARE-authorized provider for care.
- If you’re in the Philippines, you must see a Philippine Preferred Provider Network or certified providers.
- Be prepared to pay for services up front. You’ll need to file a claim later.
- You have up to three years to file your claim for overseas care.
Q: What if I have other health insurance?
A: If you have other health insurance, such as coverage through employment, TRICARE will pay after Medicare and your OHI, as described in the TRICARE For Life Handbook.
Make sure you’re fully prepared for Medicare by enrolling at least two months before turning 65. Also, keep your contact information current in DEERS to ensure you get important information regarding your TRICARE benefits.
Unlock your health—and longevity—by taking steps to understand how Medicare and TFL work together. To learn more about what happens when you become eligible, check out Becoming Medicare-Eligible.
Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.
Courtesy Story
Defense Health Agency