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TRICARE and Medicare work together

TRICARE and Medicare both provide the beneficiary with coverage. Medicare is the primary payer for services covered by both Medicare and TRICARE. TRICARE acts as the secondary payer, covering the beneficiary's out-of-pocket costs, Medicare deductibles, and cost shares (similar to a Medicare supplement). If the beneficiary has other health insurance (OHI), TRICARE will pay after Medicare and the OHI have paid.

Services covered by Medicare but not TRICARE:
Medicare will pay its portion and the beneficiary is responsible for the Medicare deductible and cost shares.

Services covered by TRICARE but not Medicare:
TRICARE will be the primary payer and the beneficiary is responsible for applicable TRICARE deductibles and cost shares. The network status of the provider determines the beneficiary's cost shares. Beneficiaries who receive care from a network provider will incur the TRICARE Extra cost share (15%). Beneficiaries who receive care from a non-network TRICARE-authorized provider will incur the TRICARE Standard cost share (20%).

Services not covered by either Medicare or TRICARE:
OHI pays if they cover the service, if OHI does not the beneficiary is responsible for the entire bill.

 

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