Jane Dotson
TRICARE For Life (TFL) is a health insurance program for military retirees and their dependents who are Medicare-eligible. TFL acts as a supplement to Medicare, providing additional coverage for services that Medicare may not cover. To receive TFL benefits, individuals must be enrolled in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). TFL covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. It also offers a pharmacy program that provides creditable drug coverage, allowing individuals to delay enrolling in Medicare Part D. TFL generally pays secondary to Medicare, covering any out-of-pocket expenses that Medicare does not, and it can be used alongside other health insurance plans.
| Characteristics | Values |
|---|---|
| Full Form | TRICARE For Life (TFL) |
| Type of Insurance | Medicare-wraparound coverage |
| Eligibility | TRICARE-eligible individuals with Medicare Part A and B |
| Coverage | Inpatient hospital care, skilled nursing facility care, hospice care, home health care, outpatient care, durable medical equipment, preventive services, prescription drugs |
| Out-of-pocket Costs | Generally none for services covered by both Medicare and TRICARE; applies for care not covered by either |
| Overseas Coverage | TRICARE is the primary payer when overseas and annual deductible/cost shares must be paid |
| Enrollment | No enrollment card required; Medicare card and military ID are proof of coverage |
| Claims | Filed by the provider with Medicare; TRICARE pays the remaining amount |
| Pharmacy Program | Offers creditable drug coverage, including prescription drugs |
| Medicare Part D | Not required for TFL; if enrolled, it becomes the primary payer for prescription drugs |
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What You'll Learn
TRICARE For Life (TFL) is Medicare-wraparound coverage
TRICARE For Life (TFL) is a Medicare supplement for those who are TRICARE-eligible and have Medicare Part A and B. It is a wraparound coverage plan, meaning it covers out-of-pocket costs that Medicare Parts A and B do not cover. These include deductibles, coinsurance, and copayments. TFL also offers a pharmacy program that provides creditable drug coverage, so enrollees do not need to enrol in Medicare Part D. However, if you do enrol in Part D, it will be the primary payer for your prescription drugs, and TFL will be the secondary payer.
TFL is available to Medicare-eligible military retirees and their dependents, regardless of age or place of residence. It also covers eligible family members, survivors, and certain former spouses of retirees.
TFL is considered the secondary payer to Medicare, which is the primary payer. This means that Medicare pays for services first, up to the limits of its coverage, and TFL covers any remaining costs. If you have other health insurance, such as employer-sponsored health insurance, TFL will pay after Medicare and your other insurance.
There are no out-of-pocket costs for services that are covered by both Medicare and TRICARE. However, there may be out-of-pocket costs for care that is not covered by either Medicare or TRICARE. When using TFL in overseas locations, TRICARE is the primary payer, and you are responsible for paying TRICARE's annual deductible and cost shares.
To enrol in TFL, you do not need an enrollment card. You only need your Medicare card and military ID as proof of coverage.
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TFL eligibility and requirements
TRICARE For Life (TFL) is a Medicare supplement for those who are TRICARE-eligible and have Medicare Part A and B, regardless of age or place of residence. TFL provides expanded medical coverage to Medicare-eligible uniformed services retirees aged 65 or older, to their eligible family members and survivors, and to certain former spouses.
To be eligible for TFL, you must have both Medicare Parts A and B. If you have other health insurance, such as a Medicare supplement or an employer-sponsored health plan, you can still use TFL as long as you have both Medicare Parts A and B. If you have TRICARE, you don’t need to join a Medicare drug plan. However, if you do, your Medicare drug plan pays first, and TRICARE pays second.
Medicare Part A (Hospital Insurance) covers inpatient costs for hospital care, skilled nursing facility care, hospice care, and some home health care. Most people are eligible for premium-free Medicare Part A if they or their spouse worked and paid Social Security taxes for at least 10 years. Medicare Part B (Medical Insurance) covers outpatient care, home health care, durable medical equipment, and some preventive services. Medicare Part B has a monthly premium based on your income.
Medicare Part D is prescription drug coverage. If you enroll in both Part D and TFL’s pharmacy program, Part D is the primary payer for your prescription drugs. However, TFL also offers a pharmacy program that provides creditable drug coverage, so you may choose to delay Part D enrollment without penalty and continue using TFL’s pharmacy program.
When using TFL in overseas locations, TRICARE is the primary payer, and you're responsible for paying TRICARE's annual deductible and cost shares.
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TFL's pharmacy program
TRICARE For Life (TFL) is a health insurance program for Medicare-eligible military retirees and their dependents. TFL offers a pharmacy program that provides creditable drug coverage. This means that if you are enrolled in the TFL pharmacy program, you can delay Part D, also known as the Medicare prescription drug benefit. Part D is offered through private companies either as a stand-alone plan or as a set of benefits included with a Medicare Advantage Plan.
The TFL pharmacy program covers medically necessary procedures, services, or equipment that meet accepted medical standards and are necessary for the diagnosis and treatment of a medical condition. It is important to note that TFL is considered secondary insurance to Medicare, meaning that it pays secondary to Medicare and covers out-of-pocket costs, including deductibles, coinsurances, and copayments.
If you enroll in both Part D and the TFL pharmacy program, Part D becomes the primary payer for your prescription drugs. However, you may want to consider keeping the TFL pharmacy program if it covers your drugs with fewer coverage restrictions. The TFL pharmacy program's formulary may also be broader than the formularies of Part D plans offered in your area.
Additionally, if you are eligible for Extra Help, you may want to consider enrolling in Part D as the drug copayments are typically lower than the copays in the TFL pharmacy program. However, as mentioned, it is important to compare the coverage restrictions and formularies of both options to determine which best suits your needs.
In conclusion, TFL's pharmacy program offers creditable drug coverage that can provide an alternative to Part D for Medicare-eligible military retirees and their dependents. It is important to carefully consider the coverage restrictions, formularies, and costs associated with both options before making an informed decision about enrolling in either program.
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TFL and out-of-pocket costs
TRICARE For Life (TFL) is a health insurance program for Medicare-eligible military retirees and their dependents. TFL is considered a Medicare supplement or wraparound coverage and is only available to those with Medicare Part A and Part B, regardless of age or place of residence.
When it comes to out-of-pocket costs, TFL covers these expenses for services that are covered by both Medicare and TRICARE. This means that you generally won't have to pay anything out of pocket if the service is covered by both programs. However, if a service is not covered by Medicare or TRICARE, you will be responsible for paying any associated costs.
It's important to understand how TFL coordinates with other insurance plans, including Medicare, as this can impact your out-of-pocket costs. TFL pays after Medicare and other health insurance plans, meaning it is the secondary payer. In other words, Medicare and any other primary insurance plans will pay first, and then TFL will cover any remaining costs, including deductibles, coinsurance, and copayments.
Additionally, TFL offers a pharmacy program that provides creditable drug coverage. This means that if you are enrolled in the TFL pharmacy program, you may not need to enroll in Medicare Part D, which is the prescription drug coverage offered by Medicare. If you do enroll in both TFL's pharmacy program and Medicare Part D, Medicare Part D will be the primary payer for your prescription drugs.
It's worth noting that TRICARE is the primary payer when using TFL in overseas locations, and you will be responsible for paying TRICARE's annual deductible and cost shares in these cases.
To avoid unexpected costs, it is recommended to check whether your healthcare services are covered by Medicare, TRICARE, or both, and to inform your healthcare providers if you have multiple insurance plans.
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TFL and Medicare: who pays first?
TRICARE For Life (TFL) is Medicare-wraparound coverage for those who are TRICARE-eligible and have Medicare Part A and B. TFL provides expanded medical coverage to Medicare-eligible uniformed services retirees aged 65 or older, to their eligible family members and survivors, and to certain former spouses.
Medicare is the primary payer and pays its portion first, and then sends the claim to the TFL claims processor. TFL is the secondary payer and covers out-of-pocket costs, including deductibles, coinsurances, and copayments.
Generally, you will have no out-of-pocket costs for services that both Medicare and TFL cover. However, you will have out-of-pocket costs for care that isn't covered by either Medicare or TFL.
If you are overseas, TFL is the primary payer and you are responsible for paying TFL's annual deductible and cost shares.
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Frequently asked questions
TRICARE For Life (TFL) is a health insurance program for Medicare-eligible military retirees and their dependents.
To be eligible for TFL, individuals must be enrolled in Medicare Part A and Part B.
TFL covers inpatient costs for hospital care, skilled nursing facility care, hospice care, and some home health care. It also offers a pharmacy program that provides creditable drug coverage.
