TRICARE For Life (TFL)

Regular Army: Retired

Benefit Fact Sheet

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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 A and B, there are no special enrollment procedures or TRICARE premium payments. 

DFAS will provide IRS Form 1095-C to all U.S. military members, and IRS Form 1095-B to all retirees, annuitants, former spouses and all other individuals having TRICARE coverage during all or any portion of tax year 2023. An IRS Form 1095 documents you (and your family members, if applicable) have the minimum essential coverage. These forms will document the information that DFAS will provide to the IRS on yourself and your authorized family members. According to the IRS, these forms are not required to prepare or file income tax returns but will be available via myPay no later than 31 January 2024.

Eligibility

Retired Soldiers who are Medicare eligible and are in receipt of retired pay are eligible for TRICARE for Life. Their dependent family members, surviving apache helicopter with stars shining overhead spouses 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 https://tricare.mil/

Benefit Highlights

Using TFL with Medicare and Other Health Insurance (OHI):

If you have other health insurance, such as a Medicare supplement or an employer-sponsored health plan, you can use TRICARE For Life as long as you have both Medicare Parts A and B.

  • If you have employer-sponsored insurance based on current employment, the other health insurance pays first, Medicare pays second and TRICARE pays last

    • In this case, your provider will file your health care claims

  • If you have OHI that is not based on your or a family member’s current employment, Medicare pays first, the OHI pays second and TRICARE pays last

    • In this case, you must file a claim with the TFL contractor. Submit a paper claim to WPS along with a copy of:

      • your provider's itemized bill

      • the Medicare Summary Notice, and

      • the explanation of benefits from all other health insurances.

Your claim must be filed within one year from the date of care. For more information, visit the WPS website.

For exact copayments for inpatient and outpatient services, please visit: https://tricare.mil/Publications/Costs

NOTE: Retirees eligible for TFL will face higher outpatient costs at VA hospitals and clinics for non-service-connected care as Medicare will not pay for services at VA facilities. Please visit: https://tricare.mil/Plans/HealthPlans/TFL/TFL_VA

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 amount

TRICARE deductible and cost-share

Not covered by TRICARE or Medicare

Nothing

Nothing

Billed charges ( which may exceed the Medicare- or TRICARE allowable amount)

To learn more about what TRICARE covers, please visit: https://tricare.mil/CoveredServices

To learn more about what Medicare covers, please visit: https://www.medicare.gov/what-medicare-covers

Additional Information

For more information, please visit the TRICARE for Life webpage maintained by the TRICARE Management Activity:
https://tricare.mil/tfl

TRICARE DEERS Information:
https://tricare.mil/DEERS

TRICARE for Life Handbook:
https://tricare.mil/~/media/Files/TRICARE/Publications/Handbooks/TFL_HBK.pdf

Medicare Part A and B information: https://www.medicare.gov/basics/costs/medicare-costs

Document Review Date: 22 January 2024