Understanding Tricaqre: Primary Or Secondary Insurance Coverage?

TRICARE is a health insurance plan available to eligible members of the US military and their families. It can be used as a primary or secondary insurance plan, depending on the individual's circumstances. For those with other health insurance, such as Medicare or an employer-sponsored plan, TRICARE can act as a secondary form of coverage, supplementing the primary insurance. In such cases, TRICARE pays after the other insurance provider, except for specific federal government programs. However, for those without other insurance, TRICARE serves as the primary payer. This distinction is essential when coordinating benefits and ensuring prompt claim payments. Understanding the role of TRICARE as primary or secondary insurance is crucial for effective healthcare planning and financial management for military personnel and their families.

Tricare is only for those with Medicare and who are Tricare-eligible

If you have other health insurance, such as Medicare or an employer-sponsored health plan, you can use TRICARE For Life as long as you have both Medicare Parts A and B. TRICARE For Life (TFL) is Medicare-wraparound coverage if you are TRICARE-eligible and have Medicare Part A and B, regardless of age or place of residence. Coverage is only for those with Medicare and who are TRICARE-eligible. Coverage doesn't extend to family members.

TFL coverage is automatic if you have Medicare Part A and B, and coverage starts the first day that Medicare Part A and B are in effect. You must pay Medicare Part B premiums. Medicare Part A is paid from payroll taxes while you are working, and your Part B premium is based on your income.

In most cases, your provider files your claims with Medicare. Medicare pays its portion first and sends the claim to the TRICARE For Life claims processor. TRICARE For Life then pays the provider directly for TRICARE-covered services. Generally, you'll have no out-of-pocket costs for services that both Medicare and TRICARE cover. You'll have out-of-pocket costs for care that isn't covered by Medicare and/or TRICARE.

If you have other health insurance, your other health insurance processes your claim first. Then, you or your doctor files your claim with TRICARE. If TRICARE gets your claim before your other health insurance processes it, TRICARE will deny it. If your other plan doesn't cover the entire cost, file a claim with TRICARE.

If you have TRICARE For Life, TRICARE becomes the second payer. When using TRICARE For Life in all overseas locations, TRICARE is the primary payer and you're responsible for paying TRICARE's annual deductible and cost shares.

Coverage is available worldwide

TRICARE For Life (TFL) is a Medicare-wraparound coverage plan that is available worldwide. It is accessible to TRICARE-eligible beneficiaries who have Medicare Part A and B, regardless of age or place of residence. This means that if you are a TRICARE beneficiary and have Medicare Part A and B, you can access TFL no matter where you are in the world.

TFL is designed to supplement Medicare, which does not provide coverage outside the United States, U.S. territories, or ships in U.S. territorial waters. Therefore, when using TFL overseas, TRICARE becomes the primary payer, and you are responsible for paying TRICARE's annual deductible and cost shares. It is important to note that this applies to both those who live overseas and those who are only travelling overseas temporarily.

If you are a TRICARE beneficiary living outside the United States, it is crucial to maintain Medicare Part B coverage to remain eligible for TRICARE, even though Medicare does not provide direct coverage in these regions.

With TFL, you have the freedom to seek care from any TRICARE-authorized provider worldwide, including overseas civilian providers, without the need for referrals in most cases. However, certain services, such as non-emergency inpatient admissions for substance use disorders and mental health care, require prior authorization.

TFL provides worldwide coverage, ensuring that TRICARE beneficiaries can access the healthcare they need no matter where they are located.

You must pay Medicare Part B premiums

TRICARE For Life (TFL) is a Medicare wraparound coverage plan for those who are TRICARE-eligible and have Medicare Part A and B, regardless of age or place of residence. Coverage is only for those with Medicare and who are TRICARE-eligible, and it does not extend to family members.

If you have TRICARE For Life, you must pay Medicare Part B premiums. Medicare Part B is a monthly premium, and the amount can change each year. You will pay the premium each month, even if you don't use any Part B-covered services. The premium is based on your income, and you can find out more about Part B premiums by visiting the Medicare website or calling Social Security.

Medicare Part B is a voluntary program, but if you don't sign up for it when you're first eligible, you will likely have to pay a penalty. This penalty is an extra 10% for each year you could have signed up but didn't, and it is added to your monthly premium for as long as you have Part B.

If you have TRICARE For Life, Medicare pays its portion first, and then TRICARE For Life pays the provider directly for TRICARE-covered services. Generally, you won't have out-of-pocket costs for services that both Medicare and TRICARE cover. However, you will have out-of-pocket costs for care that isn't covered by either Medicare or TRICARE.

If you live overseas, you must have Medicare Part B to remain eligible for TRICARE, even though Medicare doesn't provide coverage outside of the U.S. and its territories. In this case, TRICARE is the primary payer, and you are responsible for paying TRICARE's annual deductible and cost shares.

Medicare pays first, then other health insurance, then Tricare

If you have Medicare and Tricare, the order in which they pay for your healthcare depends on your situation. Medicare is the largest health insurance provider in the US, and many beneficiaries may also have other types of insurance, such as military insurance or retiree health insurance.

Medicare is the primary payer and pays first in the following situations:

• You are 65 or older and covered by a group health plan because you or your spouse is still working, and the employer has 20 or more employees.
• You are disabled and covered by an employer-provided group health plan, and the employer has 100 or more employees.
• You have End-Stage Renal Disease (ESRD), are covered by a group health plan, and have been eligible for Medicare for fewer than 30 months.
• You have ESRD and COBRA insurance and have been eligible for Medicare for fewer than 30 months.
• You are not on active duty and receive services from a non-military hospital or other approved federal provider.

Tricare is the primary payer and pays first in the following situations:

• You are on active duty and have Medicare.
• You receive services from a military hospital or clinic, or any other federal healthcare provider.

In most cases, Medicare is the primary payer and Tricare pays last. However, if you are on active duty or receive services from a military hospital, Tricare may pay first. It's important to understand how your insurance plans coordinate benefits to ensure your claims are paid promptly and correctly.

Tricare is the primary payer for those living overseas

If you are living overseas, you may be wondering how your insurance coverage works. Tricare is the primary payer for those living outside the US and its territories. This means that if you have a Medicare plan, Tricare will be the primary payer and you will be responsible for paying Tricare's annual deductible and cost shares. This includes the cost of any emergency air evacuations, which Tricare will cover if a regular ambulance cannot reach you, you are far from the nearest facility, you cannot get care at the nearest facility, or you need to be seen quickly.

If you are enrolled in Medicare Parts A and B and are travelling within the US or its territories, Medicare remains your primary payer and Tricare For Life acts as a wraparound Medicare supplement. However, when you travel outside of these areas, Medicare does not provide any coverage and Tricare becomes your primary payer in medical emergencies.

It is important to note that if you are living overseas, you must have Medicare Part B to remain eligible for Tricare, even though Medicare does not provide coverage outside of the US and its territories. This means that you must pay Medicare Part B premiums, which are based on your income.

If you have other health insurance in addition to Tricare, 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. In this case, your other insurance pays first, then Medicare, and then Tricare. If you have employer-sponsored insurance with your current employer, your employer will file your health claims. If you have other health insurance that is not based on your or a family member's current employment, you must file a claim with the Tricare For Life contractor, Wisconsin Physicians Service (WPS).

When filing a claim, you must 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.

Frequently asked questions