Tricare for Life (TFL) is the health insurance program for qualified military retirees and their eligible dependents. This is different than Medicare, which is the national health care system for many people age 65 and older and for people with certain disabilities.
For many military retirees, Medicare and TRICARE will work together to give you your health benefits.
Is Medicare or TRICARE better for retired or active-duty military members?
For many military retirees, Medicare and TRICARE will work together to help reduce or eliminate many out-of-pocket health costs and give you convenient access to good medical services.
Medicare vs TRICARE: how are they different?
Original Medicare consists of Part A and Part B. Medicare Part A mostly focuses on inpatient (hospital) care, and Medicare Part B mostly focuses on outpatient (medical) services. Both Medicare Part A and B will generally cover a broad range of healthcare needs. However, with Original Medicare, you will often still have some out-of-pocket healthcare costs in the form of coinsurance, deductible, or copay expenses.
Most Americans qualify for premium-free Medicare Part A at age 65 and should enroll as soon as they qualify. On the other hand, most Medicare recipients pay a monthly premium for Medicare Part B. While the majority of qualified people also enroll in Medicare Part B, the choice to delay this part of Original Medicare could depend upon other coverage that you have.
In contrast to Medicare, TRICARE serves as the umbrella name for the health plans for both retired and active military people in the United States. Some parts of the plan also cover family members and survivors of current or former military members. TRICARE for Life provides a Medicare-wraparound plan for people who are eligible for both TRICARE and Medicare when they are already retired.
Do you need both Medicare and TRICARE?
Since most people need to pay monthly premiums for Medicare Part B, you might wonder if you need Medicare if you already have TRICARE. It depends mostly upon your military status:
- If you’re still on active duty or qualified for TRICARE through an active family member, you can typically delay enrollment in Medicare Part B, according to the TRICARE site.
- TRICARE also states that you need to enroll in both Medicare Part A and B if you’re retired and enrolled in TRICARE for Life.
Note that your covered spouse should also enroll in Medicare Part A and B upon turning 65. If your spouse hasn’t turned 65 yet, he or she can remain on TRICARE. Likewise, when spouses turn 65 first, they should enroll in Medicare Part A and B along with TRICARE for Life.
How TRICARE coordinates benefits with Medicare
TRICARE works with Medicare to help reduce your medical expenses. The exact way TRICARE coordinates benefits with Medicare depends upon the TRICARE program you are currently enrolled in.
This briefly highlights the Medicare and TRICARE coordination of benefits:
- If you’re still active in the military, TRICARE will generally pay for Medicare-covered healthcare services. TRICARE also sometimes pays for healthcare costs that Medicare doesn’t fully cover.
- Retired members of TRICARE for life should expect Medicare to pay first for anything that it covers. In this case, TRICARE for Life usually works more like supplemental insurance. TRICARE makes an exception to this and pays for services from military or federal healthcare facilities, even if they would be covered by Medicare at another facility.
Medicare Advantage and TRICARE
Many Medicare beneficiaries who have TRICARE are also interested in Medicare Advantage plans since they sometimes provide extra benefits – such as routine dental, vision, and hearing. This is often because Medicare Advantage plans offer “extra” benefits such as coverage for chiropractic, routine dental, hearing and vision or free gym memberships. Since Medicare Part A and Part B administered by the federal government does not provide benefits for these types of services, Medicare Advantage plans are a way for people with Tricare to get these benefits at relatively little cost.
You can get a Medicare Advantage plan that will coordinate with TRICARE when it comes to providing coverage. TRICARE for life will be your primary insurance and pay first for covered medical expenses. Your Medicare Advantage plan would be your secondary insurance and pay second.
How do Tricare and Medicare Advantage provide coverage?
Tricare for Life acts as a supplement for retired military who are enrolled in a Medicare Advantage plan. This means the Medicare Advantage plan you select will be your primary insurance and pay first for covered medical expenses for inactive duty military members.
Your providers will send medical bills to the Medicare Advantage plan. After the Medicare Advantage plan pays its portion of the bill, it will forward the rest of the claim to TRICARE for processing. Typically, Tricare for Life helps pay for expenses not paid by the Medicare Advantage plan, such as copayments, coinsurance, or deductibles that would be your out-of-pocket cost if you did not have Tricare coverage. You may have no out-of-pocket expense.
Medicare Prescription Drug Coverage and TRICARE
You do not need Medicare prescription drug coverage if you have TRICARE since TRICARE offers prescription drug coverage that exceeds the requirements by law.
You do not need to enroll in a Medicare Advantage plan that include prescription drug coverage or a stand-alone Medicare Part D prescription drug plan to receive coverage.
Tricare includes benefits for prescription drug coverage that exceed the requirements of the law. As a Tricare beneficiary, you do not need to enroll in a Medicare Advantage Prescription Drug plan that combines medical and prescription drug benefits in a single plan. Instead, you may choose a Medicare Advantage plan without prescription drug coverage. Some of these Medicare Advantage plans may be inexpensive—that is, you continue to pay your Part B premium but pay $0 premium for the Medicare Advantage plan. If you decide to enroll in a Medicare Advantage Prescription Drug plan, both plans may pay their respective portion of your covered prescription drug costs as long as the pharmacy you use is in both the Medicare Advantage Prescription Drug plan and the Tricare networks of participating pharmacies.
What happens if the services I receive are not covered by Tricare and/or the Medicare Advantage plan?
Tricare and Medicare Advantage will coordinate benefits to minimize your out-of-pocket costs for covered services. However, some services that are not medically necessary are not covered by Tricare or a Medicare Advantage plan. In other instances, if your Medicare Advantage plan does not cover a particular service and Tricare does, Tricare will pay its portion for the service. You will be responsible for the Tricare deductible and any copayment or coinsurance amount. If Tricare does not cover a service that your Medicare Advantage plan covers, your Medicare Advantage plan will pay its portion for the service. You will be responsible for the Medicare Advantage plan deductible, if applicable, and any copayment or coinsurance amount.
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