Tricare is the name of the health care program used by the United States Department of Defense, Military. It was originally called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
Tricare for Life (TFL) is the name of one of the health care plans offered by Tricare. This program began in 2001 as a solution to rising out of pocket costs that Original Medicare beneficiaries were incurring. It was also meant to be an alternative to buying supplemental health care insurance.
The United States Department of Defense manages TFL and the Centers for Medicare & Medicaid Services (CMS) manage Original Medicare. These two agencies work together to coordinate the health care benefits of retirees 65 and older, or adults of any age with disabilities or end-stage renal disease.
Who is eligible for Tricare for Life?
You and your family are eligible for TFL coverage if you are listed as eligible for military health benefits in the Defense Enrollment Eligibility System (DEERS) and have Original Medicare Part B (medical insurance). To be registered in DEERS, one of the following situations must apply to you:
• You are a member of the United States military.
• You are a member of the National Guard or National Reserve of the U.S.
• You are a military survivor.
• Your former spouse was a member of the U.S. military. (This may not apply to all situations.)
• You are a Medal of Honor recipient.
No matter what your age is, if you are listed as eligible for military health benefits on DEERS and have already enrolled in Original Medicare Part B plan, you are automatically enrolled in a Tricare for Life health care coverage plan.
What is Tricare for Life and how does it work with your Original Medicare coverage?
Having TFL together with Original Medicare coverage means you can reduce your out of pocket health care costs. TFL is wraparound coverage that works simultaneously with Medicare. Some of your health care services are paid solely by your Medicare benefits, some are covered solely by TFL, and others are paid for by both plans. There are also services that neither Medicare nor TFL pay for, such as cosmetic surgery. These services are not considered to be medically necessary.
Even if you have TFL coverage, Original Medicare is the primary payer and approves all payments for your health care services if they are services normally covered by Medicare and are deemed medically necessary.
If Medicare and your TFL policy both cover a health care service, but you have depleted your Medicare benefit allowance, TFL takes over your payment and becomes your primary payer. In these cases, you must still pay your TFL deductible and all copayments or coinsurances.
For health care services normally covered by both Medicare and TFL that you get from a provider who is not Medicare approved, Original Medicare does not pay for the service. However, TFL covers the claim as the second payer and pays the amount it would have paid under normal conditions with a Medicare-approved provider.
There are some services that are not covered by TFL but are covered by Original Medicare. One example is for care given by a chiropractor. In these instances, Original Medicare pays for 80 percent of the cost (if it is medically necessary and provided by a Medicare-approved provider). You are responsible for the remaining 20 percent of the cost, plus deductibles and copays.
If you receive health care services that are not included in your Original Medicare benefits and only covered by TFL, such as health care abroad, TFL is your primary payer. You are responsible for the TFL deductible and other expenses.
Even if you have a TFL plan together with your Original Medicare Parts A and B coverage, you must continue to pay your Part B monthly premium. However, TFL does pay your Part B deductible when the services involved are covered by both Medicare and TFL.
If you have a Medicare Advantage or Medicare Supplement insurance plan, you may wish to keep it, or you may not need it together with your TFL policy. You should do your homework carefully though, and make sure you will have the coverage you need if you discontinue your current insurance plan in exchange for a TFL plan and Original Medicare Part B plan instead.