TRICARE For Life (TFL)
Regular Army: Retired
Benefit Fact Sheet
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.
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/
How TFL Works With Medicare and Other Health Insurance (OHI):
Beneficiaries with OHI, such as a Medicare supplement or employer-sponsored medical coverage, may use TFL. 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)|
For more information, please visit the TRICARE for Life webpage maintained by the TRICARE Management Activity:
TRICARE DEERS Information:
TRICARE For Life Handbook:
Document Review Date: 13 September 2013