Tricare For Life

Tricare for Life (TFL) is available at no cost to Tricare beneficiaries who have Medicare A and B coverage.

Understanding Tricare for Life

What is TFL?

TFL insurance is the type of protection referred to as Medicare-wraparound coverage. It functions as secondary coverage for individuals whose primary health insurance provider is Medicare. TFL protection defrays out of pocket medical expenses, helping covered individuals take care of costs associated with their deductibles and coinsurance responsibilities.

Who is Eligible?

Any Tricare beneficiary who is eligible for Medicare is eligible for Tricare for Life, regardless of age. In most cases, individuals become entitled to Medicare benefits at the age of 65. However, people with certain medical conditions become eligible to enroll in Medicare before reaching 65 years of age. Details about Medicare eligibility are available on the Tricare website.

There is no fee to enroll in TFL. However, in order to participate in TFL, participation in both Medicare Part A (hospital insurance) and Medicare Part B (medical coverage) is mandatory. While Medicare Part A coverage is free for eligible individuals, there are monthly fees associated with carrying Part B coverage.

What are the Benefits?

There are many benefits associated with carrying Tricare for Life coverage:

• Reduced out-of-pocket expenses for healthcare for seniors and other Medicare eligible individuals
• Ability to seek care from any Medicare healthcare provider
• No requirement for a pre-assigned manager for primary care
• Eligible for treatment at military facilities, assuming space is available
• Benefits can be coordinated with additional insurance coverage, if applicable
• Coverage beyond what is available through Medicare

How are Claims Processed?

The patient typically does not have to be involved in the claims process with the TFLs implified claims processing procedure:

• Healthcare provider files a claim with Medicare
• Medicare processes the clam
• Medicare forwards the claim to Tricare for secondary payment
• TFL makes the coinsurance payment to the provider, assuming the service performed is covered by Tricare

TFL Limitations

Carrying TFL coverage does not guarantee that covered individuals will not incur any out-of-pocket expenses for healthcare services. TFL is secondary to Medicare, providing supplemental coverage for Tricare eligible procedures. It's important to understand the circumstances under which you may face out-of-pocket expenses for healthcare even if you have both TFL and full Medicare coverage.

Services Not Covered by Medicare

Medicare does not cover healthcare treatments administered outside of the United States. If you are overseas and require medical care, your Medicare coverage will not defray the expenses incurred. If the procedures you receive are covered by Tricare, TFL will provide coverage. You'll be required to meet the Tricare deductible for the year, as well as any applicable cost shares.

Medicare Opt-Out Providers

If you choose to seek treatment from a provider that has opted out of Medicare, you may face significant out of pocket expenses. In such circumstances, Tricare will pay the secondary portion of the bill, but the patient is typically responsible for the portion that Medicare would have covered if a Medicare provider was used. Specifics about the expenses associated with using opt-out providers are available on the Tricare website.

Services Not Covered by Tricare

There are some healthcare services covered by Medicare that are outside the scope of Tricare coverage. Chiropractic care falls into this category. If you seek chiropractic treatment from a Medicare provider, your Part B coverage will apply. However, TFL will not be applied to any coinsurance or deductible because this type of care is not covered under the Tricare policy.

Uncovered Services

Some procedures are not eligible for payments from either Medicare or Tricare. Neither type of insurance provides coverage for care or procedures that are not medically necessary. If you seek cosmetic surgery, for example, you will be responsible for paying the full cost.

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