TRICARE For Life (TFL) is coverage that wraps around Medicare for TRICARE-eligible people who have both Medicare Part A and Part B. In the U.S. and its territories, Medicare pays first for Medicare-covered services, and TRICARE may pay second. TFL coverage is automatic once Part A and Part B are in effect, there's no enrollment fee, and claims usually go from Medicare to TFL's claims processor without you filing anything.
What is TRICARE For Life?
TRICARE's website describes TFL as "Medicare-wraparound coverage" for people who are TRICARE-eligible and have Medicare Part A and Part B, regardless of age or where they live. TRICARE says:
- TFL coverage is automatic if you have Part A and Part B.
- There's no enrollment fee.
- There's no separate enrollment card for TFL.
- Coverage starts the first day Part A and Part B are in effect.
You do pay Medicare Part B premiums. Keeping Part B is how you stay eligible for TFL.
Who pays first, Medicare or TRICARE?
Medicare.gov says that if you aren't on active duty, Medicare pays first for Medicare-covered services, and TRICARE may pay second. It also says that if you get items or services from a military hospital or clinic, or any other federal health care provider, TRICARE pays.
TRICARE's TFL page adds:
- Overseas: outside the U.S. and its territories, Medicare doesn't provide coverage, so TRICARE is the primary payer. TRICARE says if you live overseas, you must still have Part B to remain eligible for TRICARE.
- Other health insurance from current employment: if you have employer coverage through your own or a family member's current job, that coverage pays first.
- Other health insurance not based on current employment: Medicare pays first.
What will I pay?
What you pay depends on whether a service is covered by Medicare, TRICARE, both, or neither. TRICARE publishes a TFL Cost Matrix showing how payment works for each case. In general:
- Covered by both: Medicare pays first, and TFL pays after.
- Covered by TRICARE but not Medicare: TRICARE pays as the primary payer, and you may owe TRICARE cost-shares and deductibles.
- Covered by Medicare but not TRICARE: Medicare pays, and you pay what Medicare doesn't.
- Covered by neither: you pay.
Check the TFL Cost Matrix on tricare.mil for details.
How are claims filed?
For most care in the U.S., your provider bills Medicare. After Medicare processes the claim, it's usually sent on to TFL's claims processor. TRICARE lists WPS Government Services as the TFL contractor for the U.S. and its territories, and International SOS for other overseas areas.
If you need to file a claim yourself, TRICARE says to send it to the correct claims address listed on its site.
Why did I get a bill if I have TRICARE For Life?
Common reasons include:
- The claim hasn't reached TFL yet. Medicare may have paid, and TFL hasn't processed it.
- The provider didn't have your TRICARE information. Make sure the office has it on file.
- The service isn't covered by TRICARE.
- Medicare denied the service. If Medicare didn't pay, TFL may treat the claim differently.
- You have other insurance that should pay first, like a current employer plan.