Oct. 5, 2020 —
Will you soon be eligible for Medicare based on reaching age 65? If so, now’s the time to start thinking about your future health care needs. With TRICARE For Life (TFL) coverage, you can get the care you need while minimizing your out-of-pocket costs. As you begin to learn about TFL, you may have questions about costs, what’s covered, and if you’re eligible for it. By understanding how TRICARE and Medicare work together, you can get the most out of your coverage.
Q: What’s TFL?
A: TFL is Medicare-wraparound coverage for TRICARE beneficiaries who have Medicare Part A and Part B. It’s available worldwide and offers comprehensive health coverage, including prescription drug coverage under the TRICARE Pharmacy Program. When using TFL, you may seek care from any Medicare participating, Medicare non-participating, or opt-out providers.
Your costs under this plan depend on the type of health service you receive and whether it’s something that’s covered by Medicare, TRICARE, or both. You’ll pay nothing out of pocket for services that are covered by both Medicare and TRICARE.
“Medicare and TRICARE coordinate benefits to minimize your out-of-pocket expenses,” said Anne Breslin, TRICARE For Life program manager at the Defense Health Agency. “Since Medicare is the primary payer, it pays first—usually 80 percent of the Medicare allowable amount. TRICARE will then cover the remaining patient liability, provided the services you receive are a benefit of the TRICARE program.”
Keep in mind, you’ll have to pay out of pocket for care that isn’t covered by either Medicare or TRICARE. Not sure if a health care service you need is covered? Go to the TRICARE Covered Services page. For Medicare services, visit the Medicare website. You can also check out the TRICARE For Life Cost Matrix to see a breakdown of costs for certain Medicare and TRICARE covered services.
Q: I’m turning 65 soon. How do I enroll in TFL?
A: You don’t need to enroll in TFL. You must have Medicare Part A and Medicare Part B to keep your TRICARE benefit, or you must have proof you aren’t eligible for premium-free Medicare Part A. Be sure to sign up for Medicare Part A and Part B no later than two months before the month you turn age 65 to avoid a break in coverage. Your TFL coverage starts the day you have both Medicare Part A and Part B. You won’t have any enrollment fees. But you must pay Medicare Part B monthly premiums.
Do you have a sponsor who’s on active duty? If so, you don’t need Medicare Part B until he or she is retired. You should sign up no later than the month before your sponsor retires. This will help you avoid a break in your TRICARE coverage. Visit the Becoming Medicare-Eligible page to learn more.
Q: I’m the service member and am 62 years old. My spouse turns 65 next year. How does TFL work in this situation?
A: Your spouse should sign up for Medicare Part A and Part B two months before he or she turns age 65. If your spouse is eligible for Medicare, they’ll have TFL the first date that Medicare Part A and Part B are effective. As outlined in the TRICARE For Life Handbook, you’ll remain eligible for TRICARE Prime or TRICARE Select. You also have the option of changing health plans based on your spouse’s Qualifying Life Event of becoming entitled to Medicare. Regardless of which plan you’re in, you’ll pay the individual enrollment fee, unless you have any other dependents who are TRICARE-eligible and enrolled.
Q: I have Medicare and TRICARE. Can I get care at a Veterans Affairs facility?
A: Yes, but you may pay more. If you go to a Department of Veterans Affairs (VA) facility to get care for a non-service connected condition, Medicare won’t pay, even if it’s a Medicare covered service because VA facilities aren’t Medicare-authorized providers. TRICARE can only pay up to 20% of the TRICARE-allowable amount. You’ll be responsible for paying what’s left of the TRICARE-allowable charge to the VA. You should see VA providers only for service-connected care.
As you continue to plan for your future, carefully evaluate your health coverage needs. For example, if you’re working and have employer-sponsored coverage; referred to as other health insurance (OHI), you have the option of delaying enrollment in Medicare Part B, and relying on your employer-sponsored coverage. Under this scenario, you wouldn’t have TRICARE. Alternatively, if you’re a retired Federal civil servant and have health coverage under the Federal Employees Health Benefits Program, you may suspend this coverage and use Medicare and TFL instead. You also have the option of keeping or dropping your OHI should you choose not to delay Medicare Part B enrollment. Be sure to notify the TFL contractor if you drop your OHI coverage. Remember, TRICARE pays last after Medicare and your OHI.
Do you want to learn more about how TRICARE and Medicare work together? Check out the TRICARE and Medicare Turning Age 65 Brochure or the TRICARE and Medicare Under Age 65 Brochure. Take command of your health, and learn how TFL works.