How TRICARE for Life and Medicare Work Together

How TRICARE for Life and Medicare work together

While many individuals opt to enroll in Medicare Parts A and B, not everyone is eligible to receive additional wraparound coverage called TRICARE for Life. It’s important to understand who is qualified for this additional coverage and how Medicare and TRICARE for Life work together to cover beneficiaries.

What is TRICARE for Life?

TRICARE for Life is a medical benefit program managed by the Department of Defense (DoD) for active duty and retired uniformed service members. It’s designed to reduce out-of-pocket costs and provide overseas benefits.

Who is Eligible to Receive TRICARE for Life?

Eligible individuals include those who are registered in the Defense Enrollment Eligibility Reporting System (DEERS) who also have Medicare Parts A and B. DEERS is a database of information on uniformed services members (sponsors), U.S.-sponsored foreign military, DoD and uniformed services civilians, other personnel as directed by the DoD, and their family members.

Be sure to update your information in DEERS so you and your family can use TRICARE for Life. For example, you should update your information if you retire or separate from active duty, get married or divorced, become eligible for Medicare, or move to a new location.

When Do I Become Eligible for TRICARE for Life?

You’re eligible for TRICARE for Life on the first date you have both Medicare Parts A and B.

Will I Pay Enrollment Fees for TRICARE for Life?

No. You don’t pay any enrollment fees, but you must pay Medicare Part B monthly premiums. The specific premium amount is based on your income.

If I Have Medicare and TRICARE for Life, Will I Owe Anything for Healthcare Services I Receive?

It depends on the specific services you’re receiving and whether Medicare, TRICARE for Life or both cover those services. To determine if Medicare covers a specific service or benefit, visit www.medicare.gov or call 1-800-633-4227. To determine if TFL covers the service or benefit, visit the TRICARE website at www.tricare.mil or call Wisconsin Physicians Service—Military and Veterans Health at 1-866-773-0404.

If the service is covered by both Medicare and TRICARE for Life, you’ll have no out-of-pocket costs. The good news is that most healthcare services fall into this category. After Medicare pays its portion of the claim, TRICARE for Life pays the remaining amount, and you pay nothing.

For example, for a 30-day medically necessary inpatient hospital stay in the United States, Medicare pays 100% after you’ve met your $1,600 Part A deductible (in 2023). However, TRICARE for Life pays the deductible, which means you owe nothing.

If the service is covered only by Medicare, Medicare will pay the Medicare-authorized amount, and you’ll be responsible for the Medicare deductible and cost-share amounts.

For example, if you receive chiropractic services, Medicare Part B pays 80% after you meet the $203 deductible. TRICARE for Life pays nothing, which means you pay a 20% Medicare cost-share amount.

If the service is covered only by TRICARE for Life, TRICARE for Life will pay the TRICARE-allowable amount, and you’ll be responsible for the TRICARE deductible and cost-share amounts.

For example, on and after the 151st day of a medical necessary inpatient hospital admission, Medicare coverage ceases. The amount that TRICARE for Life pays depends on whether you’re in an in-network or out-of-network hospital. The specific amount you pay depends on whether you’re active duty or not.

For active duty family members, you’d pay $20.15 per day. However, for all others in an in-network hospital, you’d pay $250 per day or 25% of total negotiated institutional charges, whichever is less, plus 20% for separately billed negotiated professional charges. For all others in a out-of-network hospital, you’d pay $1,034 per day or 25% billed charges for institutional services, whichever is less, plus 25% of the TRICARE-allowable amount for separately billed professional charges.

If the service isn’t covered by Medicare and TRICARE for Life, you’ll be responsible for any billed charges. Note that these charges may exceed the Medicare- or TRICARE for Life-allowable amounts.

Examples of services that are generally not reimbursable by TRICARE for Life or Medicare include acupuncture, experimental or investigational services (in most cases), eye exams (routine), and hearing aids. Note that this is not an exhaustive list.

How Do I Know Whether my Provider Will Accept TRICARE for Life?

You may get healthcare services from any provider; however, what you may owe depends on whether that provider participates with Medicare, is considered a non-participating provider or whether they’ve opted out of Medicare meaning they are not allowed to bill Medicare.

Participating providers accept Medicare’s approved amount for healthcare services as full payment. Non-participating providers, on the other hand, may charge up to 15% above the Medicare allowed amount, a cost that is covered by TRICARE for Life. Opt-out providers can charge whatever they want for services but must follow certain rules to do so.

TRICARE for Life pays the amount it would have paid (normally up to 20% of the allowable charge) if Medicare had processed the claim, and you’re responsible for paying the remainder of the billed charges. To determine whether your provider participates with Medicare, visit this website. You can filter providers by whether they charge only the Medicare-approved amount.

Will I Receive a TRICARE for Life Card in the Mail?

No. You’ll simply need to show your military ID when receiving medical care.

Where Can I Find More Information About TRICARE for Life?

Call 866-773-0404 or visit their website here. Be sure to click on and download the TRICARE for Life Handbook on the right side of the page for more detailed information. Also click on and download the TRICARE for Life Cost Matrix for additional details about costs you may incur for specific services.

What If I Have Specific Questions About a TRICARE for Life Claim?

Contact a TRICARE for Life contractor. In the U.S. and U.S. Territories, visit the Wisconsin Physicians Service website. For all other overseas areas, visit the International SOS website.