TRICARE For Life
What Is TRICARE For Life?
TRICARE For Life is an additional medical coverage that applies to service members and retired service members who are enrolled in Medicare Parts A and B to help cover costs associated with medical care. TRICARE For Life applies to those who meet all qualifications to supplement medical costs not completely covered by Medicaid.
Who Qualifies For TRICARE For Life
Active Duty Service Members eligible for Medicare Part A can keep TRICARE without Medicare Part B, although it is suggested to have both so that there is no coverage gap when moving forward into retirement.
It is recommended to apply for Medicaid up to seven months before turning 65 years of age so that benefits are available immediately upon qualifying by age.
Family members of those in active duty can still qualify for TRICARE benefits if receiving Medicare Part A. Make plans to have Part B so that once your sponsor is no longer active duty, you can keep TRICARE benefits.
Make sure to enroll while the sponsoring service member is still an active duty member or as soon as possible before their retirement within eight months.
Related: Ultimate TRICARE Guide
Applying For TRICARE For Life
Those who miss their qualifying enrollment period for Part B may apply during the general enrollment time every year from January 1 through March 31.
TRICARE benefits will not start until the first day of the month following enrollment during this period. Those who apply late may be subject to a late enrollment penalty.
Medicare qualification criteria include disability benefits after 25 months of Social Security benefits, potentially those with End Stage Renal Disease after four months of dialysis, turning 65 if the potential member or spouse paid into the system for at least ten years.
- Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for iGeneral Enrollment
- Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it
- Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.
- Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for.
TRICARE Retired Reserve is available to those who are enrolled in Medicare Part A, however, it is strongly recommended to also have Part B to avoid late enrollment penalties later.
- Those who have participated in the US Family Health Plan since 2012 are allowed to stay enrolled and participate in Medicare, for those who enrolled after October 2012, the coverage will revert automatically to TRICARE For Life when reaching Medicare age.
- If you don’t qualify for Medicare Part A, you will be notified officially, although you may still qualify for Part B. Make sure to enroll in Part B once eligible to avoid late enrollment fees.
- Spouses and widows and widowers of service members follow a similar process. Widows and widowers of service members are eligible for TRICARE For Life using their spouse’s Social Security Number.
The Social Security office communicates eligibility status. Once enrolled in Medicare Parts A and B under these circumstances, your TRICARE For Life will be activated. If not eligible, apply for a new card from DEERS. You can become eligible once you are 65 years of age.
How TRICARE For Life Works
Once official, TRICARE For Life is beneficial to use. When at all possible, use an authorized service provider. Doctors and service providers can be found near you using the website. You will be asked for your Medicare card and military ID.
There is no official TRICARE For Life card, so these two forms of ID will serve as proof of coverage using your DoD Benefits number. The DoD number should be used to file claims.
Usually, the provider files the claim for you so that Medicare may pay its portion first. Then the remainder will be sent to TRICARE For Life to be processed.
Most times, with this coverage you will not have out of pocket expenses. The exception will be for services and care that are not covered by Medicare or TRICARE For Life.
To find a doctor, refer to the TRICARE For Life website. On the right hand menu, use the Find a Doctor function. You’ll be asked if you are looking to visit a Hospital/Military Clinic or an in or out of network provider. Input where you live and what TRICARE For Life plan you are on. In many cases, you’ll be directed to your PCM, or primary care manager to make appointments or get referrals. You can be treated at a military hospital or clinic if there is space.
To find a military hospital or clinic, use the search feature on the TRICARE For Life website by either location or the facility name.
TRICARE For Life Overseas
When overseas, either for travel or relocation, Medicare coverage will no longer apply. TRICARE For Life will automatically become the main provider and payer.
Despite Medicare not paying for coverage while overseas, to maintain eligibility for TRICARE, you must maintain your Medicare Parts A and B coverage. After TRICARE For Life pays its share, the patient will then be responsible for paying their deductible and applicable balances for care received.
TRICARE For Life Enrollment Fees
Generally, most will qualify for TRICARE For Life with no fees associated with membership. Due to previous work history and tax deductions while working, most eligible for Medicare Part A will also have no fees.
However, to qualify for TRICARE For Life, you must also be enrolled in Medicare Part B. Medicare Part B does have fees associated with membership which will be based on earnings.
Starting in 2024, monthly premiums for Medicare Part B will be $174.70, which may vary year to year and be higher for those with substantially higher incomes. The deductible for this plan will be $240 beginning in 2024. For most services, you will only pay 20% of the Medicare-approved amount for treatment. For more information, visit the Medicare website or call Social Security at 1-800-772-1213.
Monthly premiums for Medicare Part B may vary from year to year and be higher for those with substantially higher incomes. For most services you may only pay 20% of the Medicare-approved amount for treatment. For more information, visit the Medicare website or call Social Security at 1-800-772-1213.
Related: Ultimate TRICARE Guide
TRICARE For Life Out-of-Pocket Costs
Costs associated with the TRICARE For Life benefits depend on the type of service needed. For example, if your service is covered by TRICARE For Life and Medicare, Medicare will pay its predetermined authorized amount, and TRICARE For Life will cover the remainder. You will not be out of pocket for these services.
If the service you need is covered by Medicare and not TRICARE For Life, Medicare will pay its share, but TRICARE For Life will not cover any portion of the payment. The leftover balance can be applied to the Medicare deductible and patient.
If the service is covered only by TRICARE For Life, Medicare will not pay any percentage. TRICARE For Life will pay its allowed balance and the rest will come from the TRICARE For Life deductible and patient.
If the service is covered by neither Medicare nor TRICARE For Life, the charges would be billed.
Using TRICARE For Life with Other Health Insurance
If you have insurance through your employer or the employer of your spouse, or other individual health insurance plans, you are still eligible for TRICARE For Life coverage if you meet the qualifications of having Medicare Parts A and B. The non-TRICARE coverage may be referred to as OHI, or Other Health Insurance.
The process of using TRICARE in coordination with health insurance should be closely followed. If your current employer is providing you health insurance, the other health insurance will be first to pay, before Medicare pays its portion, and the remaining balance is paid by TRICARE.
The claim must be made through the employer.
For those who have health insurance through other means, Medicare will pay before the Other Health Insurance (OHI) and TRICARE will pay the remaining balance. To process a claim this way, first file with the TFL contractor with the bill, summary of services and policy within a year of the service rendered. For more information, visit the WPS website.
Who To Contact If You Require Assistance
There are many ways to contact TRICARE For Life if you are in need of assistance for information or a claim. The TRICARE For Life website has a live chat feature as well as email contact form. In addition, members can reach out by phone at 1-866-773-0404 for those within the U.S. or U.S. territories.
Automated Assistance by phone is available 24/7. Customer service is not available by phone on weekends and holidays. For assistance with telecommunications for the deaf (TDD), call 1-866-773-0405.
For service for those outside the U.S. and U.S. territories, refer to the TRICARE official site as contact information will vary by the location outside the U.S. using International SOS.
Related: Ultimate TRICARE Guide