TRICARE For Life and Medicare

TRICARE is the military health insurance system that provides medical coverage for over 10 million active-duty and retired military members and their families. The name TRICARE comes from the three basic plan options that the program began with in the 1990s.

Since then, the options for enrolled members have expanded to suit the various needs of its members. There are now many different options for both health and dental insurance depending on individual users’ circumstances and medical provider preferences.

There are certain exceptions for separated service members. To learn more about the specifics of enrollment and who is eligible, please visit https://tricare.mil/Plans/Enroll.

TRICARE is not Medicare, but it is health insurance. TRICARE is only meant for military or former military service members and their families. There are strict limitations on who can be eligible to use the TRICARE health program.

One big difference is that TRICARE is not limited to individuals who are 65 or older like Medicare, but some exceptions apply. For those individuals who are eligible for Medicare and already have TRICARE, Medicare will become the primary payer for healthcare and TRICARE will act as the secondary payer for coverage of coinsurance and deductibles.

According to the Defense Health Agency (DHA), there are various people who qualify for TRICARE.

TRICARE leverages the resources of the U.S. Government Military Health System, as well as civilian healthcare resources and infrastructure, to provide accessible and reliable care for all military service members and their loved ones.

While TRICARE represents the umbrella of different health care plans, services and options available to the uniformed service members, TRICARE Prime is a specific care plan available to both active and retired service members.

Active service members are required to participate in the TRICARE Prime plan as part of their active-duty responsibilities. Each member will have a Primary Care Manager (PCM) who will orchestrate care or provide referrals for care that they cannot provide. In addition, the PCM will accept copayments and be responsible for filing claims.

TRICARE Prime is only available in Prime Service Areas, which are determined by the drive time to a military healthcare facility. If service members live outside of a Prime Service Area, they can select other specialty options for TRICARE Prime, which satisfy living in remote locations or overseas.

While active-duty service members are required to enroll in TRICARE Prime, their families are not. Families and dependents of active-duty military may choose either TRICARE Prime or TRICARE Select. The provider describes the difference between the two plans as follows: “TRICARE Prime offers fewer out-of-pocket costs than TRICARE Select, but less freedom of choice for providers.”

Active-duty service members and their families have no enrollment fees or deductibles. In TRICARE Select, which offers more choice for healthcare providers, there is no enrollment fee, but there is an annual deductible which can range from $50 to $336 depending on status, coverage and service start date. The data in the table below reflect 2022 costs.

Retired Military members and their families will be required to pay annual enrollment fees, as well as annual deductibles. The data in the table below reflect 2022 costs.

TRICARE for Life (TFL) is a secondary health care plan that supplements Medicare for those who are both TRICARE-eligible and have enrolled in Medicare Part A and B. Unlike other TRICARE plans, TRICARE for Life does not extend coverage to family members or dependents that don’t satisfy these requirements.

Enrolling in TRICARE for Life is not required for active-duty service members like other TRICARE plans, but they are eligible to enroll. For those that do enroll, coverage is available worldwide and begins at the time Medicare Part A and B are in effect.

Through the enrollment in Medicare, all providers who accept Medicare will be accessible. While there are no enrollment fees, enrollees must pay for their own Medicare Part B premiums.

Although many longtime service members think of their TRICARE plan as their main health care coverage, TRICARE for Life will play a secondary role to Medicare. Health care providers will first file claims with Medicare and, if necessary, will then send claims to TRICARE for additional processing.

TRICARE for Life will pay the provider directly for any services that were not covered by Medicare and are TRICARE-covered services.

To learn more about service covered, review the TRICARE for Life Cost Matrix.

Between the two programs, most healthcare services are covered by one or both plans. However, there may still be certain procedures that will not be covered, such as cosmetic surgery, acupuncture or eye exams. So, it is important to take an active role in understanding your care and coverage.

In the event your chosen or required care is not covered fully by either plan, it can be beneficial to utilize Medicare Supplement Insurance, also known as Medigap. When traveling overseas, members should be prepared to pay upfront for care or medications and file reimbursement claims.

Medigap plans are meant to fill in the holes of Original Medicare coverage. Medicare through normal Part A and B cover many health care needs for retirees but can leave some desired or required services uninsured. This is where Medigap plans can be beneficial. Many plans will help pay for costs such as copayments, coinsurance and deductibles.

TRICARE will satisfy many, if not all, the benefits of Medigap plans with exceptions for certain health needs and special circumstances. Through TRICARE for Life, enrollees will have access to the TRICARE prescription drug plan and TRICARE will act as a secondary payer just as most Medigap plans do.

If you are considering what healthcare coverage you need, first speak to your provider who is familiar with your healthcare needs. Review the services covered and not covered by both Medicare and TRICARE to determine whether you will need to fill in any gaps.

Medicare Advantage plans are an alternative way to receive coverage for Medicare Parts A and B. These plans are offered by private health insurance companies that have been approved to offer their Medicare plans to the public.

It is unlikely that using a Medicare Advantage plan will be beneficial when paired with TRICARE for Life for a couple of reasons. The main reason is that TRICARE for Life does not pair as seamlessly with Medicare Advantage in the way Original Medicare does. This may require providers to manually process claims, which can delay billing and other administrative work.

Also, Medicare Advantage plans may not have more to offer than Original Medicare if it’s paired with TRICARE for Life. For example, one of the main reasons people choose Medicare Advantage is for prescription drug coverage, which is already covered in TRICARE for Life.

Before choosing whether to explore a Medicare Advantage plan, consult with your health care provider to explore your options. Depending on the plans available, you may be able to customize features and costs, which could provide additional benefits.

TRICARE for Life includes prescription drug coverage as part of its normal health care coverage. It is offered to all beneficiaries at no additional cost.

Routine medication should be ordered and filled through the TRICARE mail-order pharmacy process, whereas other medications for illness, surgery or emergency procedures should be purchased through a local pharmacy or on base. All medications will be billed to Medicare and TRICARE and normal co-pays will apply.