Retiree Bulletin: October 2009
TRICARE For Life and Medicare
TRICARE For Life (TFL) is TRICARE's Medicare-wraparound coverage available to all Medicare-eligible TRICARE beneficiaries, regardless of age, provided they have Medicare Parts A and B.
With TFL, TRICARE acts as a second payer to Medicare in the United States and U.S. Territories. Because Medicare does not provide coverage all other overseas areas, TFL is the primary payer and you are responsible to pay the TRICARE deductible and cost shares. Even though Medicare coverage is not available overseas, you must have both Medicare Parts A and B to remain eligible for TRICARE and TFL.
If you are 65 years of age or older but not eligible for Medicare you may still be eligible for TFL. Contact the Social Security Administration and apply for Medicare eligibility. If you are denied, send the Letter of Denial to the Defense Manpower Data Center Support Office (DSO) by calling 1-800-538-9552 or for the hearing impaired (TTY/TDD): 1-866-363-2883. You may also visit the DEERS Web site.
For information about Medicare Part B:
If you have any questions, please contact the TRICARE Area Office-Pacific (TAO-P).
Medicare-Eligibility and TRICARE
If you have Medicare Part A, you are required by law to have Medicare Part B coverage to retain your TRICARE benefits with one exception. Active duty family members entitled to Medicare Part A are not required to purchase Medicare Part B coverage. When the active duty service member retires, family members must have Medicare Part B coverage in place upon the date of retirement to avoid loss of TRICARE benefits.
Medicare Part B
The Department of Defense (DoD) encourages beneficiaries to purchase Medicare Part B when they are first eligible. Although beneficiaries may delay Medicare Part B sign up to eight months in certain circumstances, they will not be covered by TRICARE until Part B coverage begins. Beneficiaries that do not sign up for Medicare Part B when first eligible will pay a 10 percent surcharge for each 12-month period that they delayed signing up.
You can confirm that your Medicare status is current in DEERS by calling 1-800-538-9552 or for the hearing impaired (TTY/TDD): 1-866-363-2883. You may visit DEERS Web site to update your personal information.
You will sign up for Medicare Part B during your initial enrollment period which begins three months before the month of your 65th birthday and ends three months after the month of your 65th birthday. Note: Although the eligibility age for full Social Security benefits is changing, the eligibility age for Medicare is not.
If you do not purchase Medicare Part B when you first become eligible, you may sign up for Part B during the general enrollment period that occurs January 1 through March 31 of each year. If you do enroll in Part B during the general enrollment period, Part B and TFL coverage will begin July 1 of that year.
Employer Group Health Plan Coverage
If you have group health plan coverage based on your current employment or that of a family member, you are not required by Medicare to sign up for Part B. You may sign up for Medicare Part B without paying the surcharge for late enrollment as long as you were covered by an employer group health plan or you may delay signing up for up to eight months after employment or health plan coverage ends, whichever comes first. However, you must have Medicare Part B to remain eligible for TRICARE even though Medicare does not require Part B in this scenario. If you do not purchase Medicare Part B, you will lose your eligibility for TRICARE.
How TFL Works
In the United States and U.S. Territories like Guam, TFL is the second payer after Medicare in most cases. Basically, if you use a Medicare provider, he or she will file your claims with Medicare. Medicare pays its portion and electronically forwards the claim to the TFL claims processor. TFL pays the provider directly for TRICARE-covered services.
- For services covered by both Medicare and TRICARE, Medicare pays first and TFL pays your remaining coinsurance for TRICARE-covered services.
- For services covered by TRICARE but not by Medicare, TFL pays first and Medicare pays nothing. You must pay the TRICARE fiscal year deductible and cost shares.
- For services covered by Medicare but not by TRICARE, Medicare pays first and TFL pays nothing. You must pay the Medicare deductible and coinsurance.
- For services not covered by Medicare or TRICARE, Medicare and TRICARE pay nothing and you must pay the entire bill.
In all overseas areas (such as Japan or Korea) Medicare does not provide coverage so TFL is the primary payer. You will visit any host nation provider for care and pay the same cost-shares as you did before you became eligible for Medicare. In most cases, you’ll pay the provider directly and file a claim with the overseas claims processor—just like you did when you were using TRICARE Standard Overseas.
There are no enrollment fees for TFL, but you must pay Medicare Part B premiums. Your Part B premium is based on your income. For more information about Part B premiums, visit www.medicare.gov or call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
If you’re using TFL in one of the U.S. Territories in the TRICARE Pacific Area, you’ll have no out-of-pocket costs when the services are covered by both Medicare and TRICARE. If receiving care in an area where Medicare does not provide coverage, you are responsible for paying the TRICARE annual deductible (Individual: $150/Family: $300) and cost-shares (25%).
How TFL Works With Medicare and Other Health Insurance
If you have other health insurance (OHI), such as Medicare supplement or employer-sponsored medical coverage, you may still use TFL. By law, TRICARE pays claims only after all other OHIs have paid. Therefore, in most overseas areas, the OHI will pay first and TFL will pay second. In the U.S. or a U.S. Territory, Medicare will pay, then the OHI and TFL will pay last. In either scenario, you will then need to file a paper claim with TRICARE for any out-of-pocket expenses.
Filing TFL Claims
If receiving care from a provider that accepts Medicare in one the U.S. Territories, your provider will file the claim with Medicare. Medicare then processes the claim and forwards the claim to TRICARE for payment of the remaining amount. TRICARE automatically sends payment to your provider. You will not have to file a claim unless you have OHI. You will get a Medicare summary notice from Medicare and an EOB from WPS indicating the amounts Medicare and TRICARE paid.
When seeking reimbursement for care received in locations not covered by Medicare, you must file your own claim(s). Paper claims are submitted to the TRICARE Overseas claims processor using a DD Form 2642, along with a copy of the provider’s itemized bill and any explanation of benefits from all OHIs; no Medicare summary notice is required. Send your claims to:
P.O. Box 7985
Madison, WI 53707-7985
For more information about filing overseas claims, you may use the following resources:
Services in Military Treatment Facilities (MTF)
TFL beneficiaries may receive care in MTFs on a space-available basis.
Medicare Part D
Unlike Medicare Parts A and B, purchase of a Medicare Part D prescription drug plan is not required to retain TRICARE eligibility. Click here for more information.
For More Information
There are many resources for more information.
- Contact the TAO-P Regional Customer Service Center
- Visit the TRICARE Beneficiary Web Site. When entering your “profile,” select “TRICARE For Life” as you plan. Then click through the site to view information tailored specifically to you.
- Contact the TFL contractor, WPS-TFL
- WPS TFL
P.O. Box 7890
Madison, WI 53707-7890