Tricare For Life and Medicare
Tricare for Life is health care coverage for military members, retirees and their families who have Medicare Part A and Part B. It provides prescription drug coverage through the Tricare Pharmacy Program. You must be eligible for both Tricare and Medicare to qualify for Tricare for Life.
What Is Tricare for Life?
Tricare is the health care program for members of the U.S. uniformed services, retirees, and their families. It provides comprehensive coverage including health, prescription and dental plans.
Tricare for Life (TFL) is extended health insurance from Tricare designed to work with Medicare. It is an option for people who already have Tricare — or are eligible for it — and who have Medicare Part A and Part B.
There are no restrictions on your age or where you live. Tricare for Life is available worldwide to those who meet Tricare and Medicare eligibility requirements.
When you receive health care in the United States and its territories, Medicare pays first and Tricare for Life will pay the remaining costs. But if you seek health care outside the U.S. and its territories, TFL is the primary payer — meaning it pays first.
Medicare generally does not pay for medical care you receive outside the U.S. and its territories.
How Does Tricare for Life Work with Medicare
Tricare for Life is intended to reduce your out-of-pocket health care costs, including prescription drug expenses and some copayments and deductibles for Medicare. It also helps pay if you need health care while traveling overseas.
With both Medicare and TFL, you can seek care at any Medicare participating provider. You can seek care through a non-participating provider as well, but Medicare will only cover the Medicare approved cost. You can also seek care at any military hospital, but on a space-available basis only.
What You Pay with Both Medicare and Tricare for Life
There are no enrollment fees for either program. But you have to pay the monthly Medicare Part B premium — $144.60 in 2020 — to participate in both Medicare and Tricare for Life.
You may also have to pay some out-of-pocket costs in certain situations.
|Health Care Services||Your Share of Costs|
|Medical services covered by Medicare but not Tricare||Medicare deductibles, copayments or coinsurance|
|Medical services covered by Tricare but not Medicare||Tricare deductibles, copayments or coinsurance|
|Medical procedures not covered by either Tricare or Medicare||Entire cost|
|Health care services covered by both Medicare and Tricare||You have no out-of-pocket expenses|
Prescription Drug Coverage with Medicare and Tricare for Life
Medicare requires you to have prescription drug coverage. Tricare for Life provides the required creditable drug coverage so you don’t have to buy a Medicare Part D prescription drug plan.
But you are free to buy a Part D plan if you want. There are some advantages to having both.
TFL has its own drug formulary — a list of drugs it covers which may change from year to year. It may not cover some drugs that a Medicare Part D plan would.
Tricare for Life only covers prescriptions written by doctors or other health care providers at Veterans’ Administration (VA) hospitals or other approved facilities.
TFL also requires you to use military pharmacies, its mail-order pharmacy or retail pharmacies in its network. If you use non-network pharmacies, you have to pay full price for drugs up front and then seek reimbursement from Tricare.
A Medicare Part D drug plan may give you more options to receive prescriptions from private sector doctors and pick up prescriptions at local retail pharmacies.
Tricare for Life and Medicare Advantage Plans
Medicare Advantage plans are sold by private insurers that contract with Medicare. They are required to cover everything that Original Medicare covers. But they may offer additional benefits such as vision, hearing, prescription drug and dental coverage.
Medicare Advantage plans have their own network of health care providers to keep their costs and yours lower. If you choose to use health care providers outside your plan’s network, you may have to pay more out-of-pocket costs.
This may limit your health care options compared to TFL and Original Medicare.
Plans may also include prescription drug coverage, which you already have under Tricare for Life. If you don’t want to pay for the dual coverage, you can shop for a Medicare Advantage plan without prescription coverage.
You should check your Tricare for Life Handbook and talk with the Medicare Advantage plan’s administrator before deciding on a Medicare Advantage plan.
7 Cited Research Articles
- Tricare. (2020, September 1). How Tricare for Life Eligibility, Enrollment Works. Retrieved from https://tricare.mil/CoveredServices/BenefitUpdates/Archives/01_28_20_How_TRICARE_For_Life_Eligibility_Enrollment_Works
- Tricare. (2020, January 16). Filling Prescriptions with Tricare: You’ve Got Options. Retrieved from https://www.tricare.mil/CoveredServices/BenefitUpdates/Archives/01_16_20_Filling_Prescriptions_With_TRICARE
- Health Net Federal Services. (2019, October). Tricare and Medicare under Age 65. Retrieved from https://www.hnfs.com/content/hnfs/home/tw/bene/res/beneficiary-education-materials/tricare_for_lifeandmedicare.html
- Health Net Federal Services. (2019, October). Tricare and Medicare Turning Age 65. Retrieved from https://www.hnfs.com/content/hnfs/home/tw/bene/res/beneficiary-education-materials/tricare_for_lifeandmedicare.html
- Tricare. (2017, December 19). Becoming Medicare-Eligible. Retrieved from https://www.tricare.mil/medicare
- California Health Advocates. (2009, February 26). People with Medicare and Tricare for Life. Retrieved from https://cahealthadvocates.org/wp-content/uploads/2016/04/F-002-CHAFactSheet.pdf
- Military.com. (n.d.). Tricare for Life. Retrieved from https://www.military.com/benefits/tricare/retiree/tricare-for-life.html