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TRICARE for Life

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TRICARE for Life (TFL) originated to fulfill a promise of life-long health care many were given when they first joined the military.

Prior to 2001, TRICARE coverage expired at age 65 forcing military retirees, their families, and survivors to rely solely on Medicare. TFL provides military health care coverage to TRICARE beneficiaries 65 years of age or older.

TFL Update: Prior to August 20, 2012, U.S. Family Health Plan enrollees were not required to participate in Medicare or TFL. However, due to a change in the law, anyone who enrolls after the August deadline will be required to exit the USFHP on their 65th birthday. All those who enrolled prior to the deadline may remain in the USFHP system.

When TRICARE beneficiaries (other than eligible active duty family members) become entitled to Medicare Part A, on the basis of age or disability/end-stage renal disease and purchase Medicare Part B, they do not experience a break in TRICARE coverage. TRICARE For Life (TFL) pays secondary to Medicare. The following is a summary of TRICARE for LIFE and dual eligibility:

Tricare for Life Eligibility

TFL is available for all dual TRICARE-Medicare-eligible uniformed services retirees, including retired members of the Reserve Component who are in receipt of retired pay, Medicare-eligible family members, Medicare-eligible widows/widowers, certain former spouses, and beneficiaries under age 65 who are also entitled to Medicare Part A because of a disability or chronic renal disease. Dependent parents and parents-in-law are not eligible for TRICARE benefits-except TRICARE Senior Pharmacy benefits-and they may continue to receive services within a military treatment facility on a space-available basis. In order to eligible for TRICARE Senior Pharmacy benefits, they must be entitled to Medicare Part A, and if they turned age 65 on or after April 1, 2001, be enrolled in Medicare Part B.

TFL Cost to Beneficiaries

There are no enrollment fees for TFL. Beneficiaries, other than active duty family members, are required to purchase Medicare Part B and MUST pay the appropriate Medicare Part B monthly premiums. Beneficiaries may check with the Social Security Administration online at www.ssa.gov, call toll-free at (800) 772-1213 or visit Medicare online at www.medicare.gov for more information about enrolling in Medicare Part B and monthly premiums that apply.

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Tricare for Life Benefits:

  • For services payable by both Medicare and TFL, Medicare pays first, any other health insurance pays second, and the remaining beneficiary liability may be paid by TFL.
  • For services received from a civilian provider, the provider first files claims with Medicare. Medicare pays its portion and electronically forwards the claim to TFL for processing. TFL sends its payment for the remaining beneficiary liability directly to the provider, and beneficiaries receive a Medicare summary notice (from Medicare) and a TFL explanation of benefits (EOB) that indicates the amount paid to the provider.

    The claims processing linkage between Medicare and TFL is now available for the under age 65 dual-eligible population. All TFL claims for dual-eligible beneficiaries under age 65, as well as age 65 and over, will go to a new, centralized claims processor. The new contractor, Wisconsin Physicians Service (WPS), has agreements with each Medicare carrier allowing Medicare to submit claims directly to WPS TFL or, before transition, to the regional TFL claims processor. (The regional phase-in dates for the WPS TFL contract are listed below.) The beneficiary's Social Security Number must be in the Defense Enrollment Eligibility Reporting System (DEERS) for the electronic claims process to work.
  • For services payable by TFL, but not Medicare, such as overseas care, TFL pays the same as for TRICARE Standard beneficiaries. Beneficiaries are responsible for the TRICARE Standard fiscal year deductible and cost shares.
  • For services payable by Medicare, but not TFL, such as chiropractic services, Medicare pays as usual, however, TFL makes no payment. Beneficiaries are responsible for Medicare coinsurance and deductibles.
  • For services not payable by Medicare or TRICARE, beneficiaries are responsible for the entire bill.

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Medicare Part B and Eligibility Based on Age

Through the Defense Manpower Data Center's (DMDC's) Defense Enrollment Eligibility Reporting System (DEERS) beneficiaries are notified within 90 days before their 65th birthday that their medical benefits are about to change. DMDC asks beneficiaries to contact the nearest Social Security Administration office or Medicare regarding their eligibility for Medicare. Beneficiaries MUST elect to enroll in Medicare Part B in order to be eligible for TFL. Once a beneficiary is enrolled in Medicare Part B, TFL pays secondary to Medicare beginning on the first day of the month the beneficiary turns 65. If a beneficiary's 65th birthday is on the 1st day of the month, eligibility for Medicare and TFL begins on the 1st day of the previous month. Beneficiaries may visit the Social Security Administration online at www.ssa.gov or call toll free at (800) 772-1213 (TTY/TDD [800] 325-0778) for more information on enrolling in Medicare Part B.

Beneficiaries who are age 65 and older and who have Medicare Part A only may enroll in Medicare Part B during the general enrollment period, which runs from January 1 to March 31 every year. Medicare Part B coverage begins on July 1 of the year in which they enroll.

Medicare Part B and Eligibility Based on Disability or Chronic Renal Disease

Beneficiaries entitled to Medicare Part A because of a disability or chronic renal disease MUST enroll in Medicare Part B to be eligible for TRICARE For Life (if other than active duty family members). They may enroll during the general enrollment period that occurs Jan. 1 through March 31 of each year. Part B coverage begins the following July.

"When you turn 65 and become eligible for Medicare, or you obtain Medicare eligibility due to disability or end-stage renal disease (ESRD), your TRICARE benefits will change as follows:

1. You will become eligible for TRICARE for Life instead of TRICARE Standard, Extra, and Prime.*

2. If you are enrolled in TRICARE Prime you will automatically be disenrolled.*

* Medicare-eligible beneficiaries under age 65 may enroll or remain enrolled in TRICARE Prime, to retain priority status at a Military Treatment Facility (MTF)."

(Active duty family members, regardless of age, do not have to enroll in Medicare Part B to remain eligible for TRICARE. A special enrollment period is available for active duty family members whose sponsor retires. They may enroll in Part B at any time before the active duty sponsor retires or during the eight-month period that begins the month the active duty sponsor retires.)

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TRICARE For Life Overseas

Eligible beneficiaries living overseas may use TFL as long as they are enrolled in Medicare Part B. Since Medicare does not typically provide health care coverage overseas, TRICARE provides the same TRICARE Standard benefits available to retirees under age 65, and beneficiaries are responsible for the TRICARE Standard cost shares and deductibles.

Services in Military Treatment Facilities

Beneficiaries using TFL may continue to receive care in military treatment facilities on a space-available basis. Under the program TRICARE Plus, they may be allowed to enroll in a military treatment facility for primary care. TRICARE Plus is based on local availability.

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TRICARE For Life and Other Health Insurance (OHI)

If you have OHI, by law, TRICARE will process your claims only after all OHIs have processed the claim. After your OHI and Medicare process your claim, you will need to file a TRICARE claim with Wisconsin Physicians Service (WPS)/TFL (the TFL claims processing contractor). For detailed information on how to file a claim, please visit the TFL Claims page.

If a beneficiary receives a service that is not covered by Medicare, such as a prescription medication, TFL follows TRICARE's other health insurance rules in determining what portion to pay. The beneficiary may need to file a claim with WPS TFL. TRICARE pays either the amount it would have paid as the primary plan or any remaining beneficiary liability after all OHI has paid, whichever is less.

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TRICARE for Life and VA

VA providers cannot bill Medicare and Medicare cannot pay for services received from VA.

If you are eligible for both TFL and VA benefits and elect to use your TFL benefit for non-service-connected care, you will incur significant out-of-pocket expenses when seeing a VA provider.

If you receive care at a VA facility, you may be responsible for 80 percent of the bill. By law, TRICARE can only pay 20 percent of the TRICARE-allowable amount.

When using your TFL benefit, your least expensive option is to see a Medicare participating or Medicare non-participating provider.

If you want to seek care from a VA provider,check with a Beneficiary Counseling and Assistance Coordinator (BCAC) to confirm coverage details and determine what will be covered by TRICARE.

To find a BCAC, search the Customer Service Community Directory at www.tricare.mil/bcacdcao.

Affordable Care Act

The Affordable Care Act, also known as the health care reform law, requires that individuals maintain health insurance or other health coverage that meets the definition of "minimum essential coverage" beginning in 2014.

Please be aware that both the TRICARE and Medicare programs are considered minimum essential coverage. Most people who do not meet this provision of the law will be required to pay a fee for each month they do not have adequate coverage. The fee will be collected each year with tax returns.

You can find other health care coverage options at www.healthcare.gov.

Claims Processing Information

As a dual-eligible beneficiary entitled to Medicare Part A, and enrolled in Medicare Part B you do not need to submit a paper claim. Medicare pays its portion for Medicare covered services and automatically forwards the claim to WPS TFL for processing.

If you have other health insurance (OHI) your claim will not automatically cross over to TRICARE. You will need to file a claim with WPS TFL. Submit your Medicare Summary Notice along with a TRICARE paper claim (DD Form 2642) and your OHI's Explanation of Benefits (EOB) statement to:

WPS/TFL
P.O. Box 7890
Madison, WI 53707-7890

For general information about TRICARE, call the toll-free TRICARE information line for your region found at the TRICARE Contact Us web page.

For more information or assistance with TFL, please call WPS TFL at 1-866-773-0404. If you need further information regarding your Medicare benefits, call 1-800-MEDICARE (1-800-633-4227).

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