Q&A: Learn the basics of TRICARE For Life coverage

FALLS CHURCH, Va. — TRICARE For Life offers healthcare coverage for TRICARE beneficiaries who also have Medicare Part A and Part B. Like all health plans, there are important details that can help you make the most of your benefits.

“TRICARE For Life is a comprehensive health plan available worldwide,” said Anne Breslin, Program Manager, TRICARE For Life, TRICARE Health Plan, at the Defense Health Agency. “Medicare is the primary or first payer, so it’s important that you become familiar with Medicare before your coverage starts.”

This article answers some of the more common questions about TFL. For more in-depth information, check out the TRICARE For Life Handbook.

Q: What is TFL?

A: TFL is Medicare-wraparound coverage. This means that TRICARE pays for many of the medical expenses not covered by Medicare. If you’re eligible for Medicare Part A, you must have Medicare Part A and Part B to have TFL. This is true regardless of your age, or where you live.

Q: How do I enroll?

A: TFL coverage is automatic when you sign up for Medicare Part A and Part B. There are no enrollment forms or enrollment fees for TFL. The Medicare program informs the Defense Enrollment Eligibility Reporting System when they begin to cover a TRICARE beneficiary. If you’re 65 years old, you’ll need to renew your Uniformed Services ID card after you get your Welcome to Medicare letter. All you need for proof of coverage is your Medicare card and Uniformed Services ID card.

Your record in DEERS must reflect your eligibility for TRICARE. Keep your and your family’s contact information up to date in DEERS to avoid enrollment problems.

Q: What changes when I enroll?

A: While your medical coverage is the same, TFL beneficiaries have different access to providers at military hospitals and clinics than before. Unlike TRICARE Prime, TFL beneficiaries primarily seek care with civilian Medicare providers. You may continue to get care at a military hospital or clinic if space is available, or if you have the option to enroll in TRICARE Plus at a military hospital or clinic.

Q: What do Medicare and TFL cover?

A: Together with Medicare, TFL provides a comprehensive healthcare benefit. In some cases, TFL provides added benefits. For example, TFL covers skilled nursing facility costs beyond Medicare’s 100-day limit.

TFL beneficiaries remain eligible for the TRICARE Pharmacy Program. Go to Pharmacy Costs to see TRICARE Pharmacy Program costs.

Neither Medicare nor TFL cover long-term care such as independent or assisted living. However, you may qualify to buy long-term care insurance through commercial insurance programs or through the Federal Long Term Care Insurance Program.

Q: When will I have a copayment or cost-share?

A: As described in the TRICARE For Life Handbook, there are four scenarios to consider around out-of-pocket costs:

• Medical services covered by Medicare and TRICARE
  When you see a Medicare participating or Medicare non-participating provider, you have no out-of-pocket costs for services covered by both Medicare and TFL. Most healthcare services fall into this category. After Medicare pays its portion of the claim, TRICARE pays the remaining amount, and you pay nothing.
• Medical services covered by Medicare, but not by TRICARE
  When you get care that’s covered by Medicare only, Medicare processes the claim as the primary payer and pays the Medicare-allowed amount. TRICARE pays nothing. You’re responsible for the Medicare deductible and cost-share and any remaining billed charges.
• Medical services covered by TRICARE, but not by Medicare
  When you get care that’s covered only by TRICARE, TRICARE processes the claim as the primary payer and pays the TRICARE-allowable amount. You’re responsible for any TRICARE deductibles and coinsurance.
• Medical services not covered by Medicare or TRICARE
  When you get care that isn’t covered by Medicare or TRICARE, neither pays on the claim. You’re responsible for the entire bill.

Refer to the TRICARE For Life Cost Matrix for a breakdown of costs for certain Medicare and TRICARE covered services.

Q: What about Medicare Advantage Part C, and Medicare drug coverage Part D?

A:

• Part C: Medicare Advantage is optional coverage offered by private companies that contract with Medicare to provide the same services as Parts A and B. Some provide prescription coverage as well. You’ll usually need prior authorization before seeing medical specialists like cardiologists, dermatologists, or orthopedic surgeons. If you sign up for Medicare Advantage, you may pay a monthly plan premium, plus your Medicare Part B premium. You’ll also have to make copayments at the time of service. This means you’d file a claim with TRICARE for reimbursements of copayments for TRICARE-covered services. You must also get healthcare services from the Medicare Advantage plan’s network of providers, except for emergency services.
• Part D: TFL beneficiaries remain eligible for prescription drug coverage through the TRICARE Pharmacy Program. You aren’t required to have Medicare Part D to have TRICARE prescription drug coverage. In some cases, you may benefit from buying a Medicare Part D plan. For example, Part D plans sometimes cover drugs that aren’t covered by TRICARE.

Q: What if I have other health coverage, like an employer-sponsored plan?

A: If you’re turning 65 and have employer-sponsored health insurance, you can:

• Keep your employer-sponsored coverage, and enroll only in Medicare Part A. In this case, you won’t have TRICARE coverage. TFL takes effect on the first date that your Medicare Part A and Part B coverage are effective.
• Keep your employer-sponsored coverage and also enroll in Medicare Parts A and B. TFL is effective the first date that both your Medicare Parts A and B take effect. TRICARE is the last payer after your employer coverage and Medicare have paid their portion of the claim.
• Decline your employer-sponsored coverage and enroll in Medicare Parts A and B. TFL is effective the first date that both your Medicare Parts A and B take effect. Medicare will be the first payer and TRICARE pays after.

Employer-sponsored health plans may cover providers, services, or items that Medicare and TRICARE don’t. Compare your employer group health plan benefits and costs to your Medicare and TRICARE benefits and costs to find what’s best for you.

Q: What about dental and vision coverage?

A: TFL doesn’t provide dental coverage. But TFL beneficiaries can enroll in dental and vision insurance available through the Federal Employees Dental and Vision Insurance Program.

Q: What if I’m overseas?

A: TRICARE is the only payer overseas. Medicare provides coverage in the U.S. and U.S. territories. If you live overseas, you’ll still need to have Medicare Part A and Part B to have TFL coverage.

While living or traveling overseas, TFL beneficiaries may get covered services and supplies from a network provider or any authorized TRICARE provider. Contact the TRICARE overseas contractor for help finding a civilian provider.

No matter where you go next, your TRICARE coverage goes with you.