TRICARE For Life (TFL)

Regular Army: Retired

Benefit Fact Sheet

Tweet
Share

Summary:

TRICARE for Life (TFL) is TRICARE's Medicare-wraparound coverage available worldwide to TRICARE beneficiaries who are also entitled to Medicare. Essentially, TFL acts as a supplement to Medicare Part B except there are no special enrollment procedures or TRICARE premium payments.

Eligibility:

Retired Soldiers who are Medicare eligible and are in receipt of retired pay are eligible for TFL. Their dependent Family Members, widows/widowers and certain former spouses are also eligible.

Dependent parents and parents-in-law are not eligible for TFL. When TRICARE beneficiaries become entitled to Medicare Part A and B (1) on the basis of age (65), (2) disability, or (3) end-stage renal disease, they are eligible for TFL. Note: In order to be covered under TFL, beneficiaries must be enrolled in Medicare Part B and have a current military ID card.

Beneficiaries entitled to Medicare Part A who decline Medicare Part B coverage will lose TRICARE eligibility.

The key to TRICARE eligibility depends on enrollment in the Defense Enrollment Eligibility Reporting System (DEERS), which will indicate the dates of eligibility. All uniformed services sponsors (active, reserve or retired) should ensure that their family status (marriage, death, divorce, new child, etc.) and residential address are current in DEERS at all times.

TRICARE Benefits change frequently so be sure to reference the TRICARE site at http://www.tricare.mil/

Benefit Highlights:

How TFL Works With Medicare and Other Health Insurance (OHI):

Beneficiaries with OHI, such as a Medicare supplement or an employer-sponsored health plan, you may use TFL as long as you're eligible for Medicare Part A and have Medicare Part B coverage. By law, TRICARE pays claims only after all OHIs have paid. Typically, after Medicare processes a claim-either approving or denying it-the claim is automatically forwarded to the beneficiary's OHI. Once the OHI processes the claim, the beneficiary needs to file a paper claim with TRICARE for any out-of-pocket expenses. TRICARE may reimburse the beneficiary if the services provided are covered by TRICARE. Exact copayments for inpatient and outpatient services can be found on TRICARE's website.

NOTE: Retirees eligible for TFL will face higher outpatient costs at VA hospitals and clinics beginning Oct. 1, 2013, for non-service-connected care.

TRICARE For Life Out-of-Pocket Costs

Type of Service

Medicare Pays

TRICARE Pays

You Pay

Covered by TRICARE and Medicare

Medicare-authorized amount

Remaining amount

Nothing

Covered by Medicare only

Medicare-authorized amount

Nothing

Medicare deductible and cost-share

Covered by TRICARE only

Nothing

TRICARE-allowable charge

TRICARE deductible and cost-share

Not covered by TRICARE or Medicare

Nothing

Nothing

Billed charges (which may exceed the Medicare amount or balance-billing cap)

Additional Information:

For more information, please visit the TRICARE for Life webpage maintained by the TRICARE Management Activity:
http://www.tricare.mil/Welcome/Plans/TFL.aspx

TRICARE DEERS Information:
http://www.tricare.mil/DEERS

TRICARE For Life Handbook:
http://www.tricare.mil/~/media/Files/TRICARE/Publications/Handbooks/TFL_HBK.ashx

Document Review Date: 5 March 2014