How do TRICARE and Medicare work together?

ApexHealth - how do tricare and medicare work together?

Active duty and retired military personnel are very familiar with TRICARE, the health care program for uniformed service members, retirees, and their families around the world. TRICARE for Life (TFL) is the health insurance program for TRICARE beneficiaries who have Medicare Parts A and B, and it’s different than Medicare, but the two can work together. We’ve received a lot of questions from military retirees related to Medicare, Medicare Advantage and TRICARE, so we decided to provide some information we hope you’ll find helpful.  

How do I find out if I’m eligible for TRICARE for Life?

TFL is an option for Medicare-eligible TRICARE beneficiaries, regardless of age or where you live. In order to receive these benefits, you must be enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) and your Defense Enrollment Eligibility Reporting System (DEERS) record must reflect your eligibility for TRICARE. We recommend checking out TRICARE’s website for more detailed information.

You’re eligible to enroll in Medicare 3 months prior to the month you turn 65. Once you’re enrolled in Parts A and B, you’re automatically enrolled in TFL. Your TFL coverage begins on the first day you have both Medicare Parts A and B. This is good news – you won’t need to fill out any enrollment forms or pay any enrollment fees for TFL.

How does Medicare work with TRICARE?

TRICARE and Medicare work together to decrease your out-of-pocket costs. Generally, Medicare pays first (is the primary payer) and TFL pays second (is the secondary payer), functioning like supplemental insurance. When you receive services covered by both Medicare and TFL, your doctor’s office will file the claim with Medicare; Medicare will then process the claim, pay their portion, send the bill to TFL, and they’ll pay the remaining costs. Just remember, you’ll have to pay your Medicare Part B premium and there’s no monthly premium for TFL.

If you have TFL and a Medicare Advantage plan, TRICARE generally still pays last after your Medicare Advantage plan. After your Medicare Advantage plan processes the claim from your provider and you’ve paid your cost-share for services, you may file a claim with TFL on your own to be reimbursed. If you have any questions about coordination between TFL and a Medicare Advantage plan, you can contact TFL directly. If you are interested in ApexHealth and how we work with TFL, give us a call to speak with an ApexAssistant.

Can I enroll in a Medicare Advantage plan if I’m also enrolled in TRICARE for Life?

Absolutely! If you are enrolled in TFL, you can also enroll in a Medicare Advantage plan. TRICARE works with a Medicare Advantage plan similar to the way it works with Original Medicare.  Medicare Advantage plans may interest Medicare beneficiaries with TFL because they offer extra benefits that Original Medicare does not cover. These include routine dental, vision and hearing services plus extra benefits such as over-the-counter drug and supply allowance, free gym memberships and routine chiropractic services . Like with Medicare, TFL pays for expenses for services covered by both Medicare and TFL and not paid for by your Medicare Advantage plan, including out-of-pocket costs such as coinsurance, copayments or deductibles. This helps cut down on any out-of-pocket expenses. Just remember, you’ll have to pay your Medicare Part B premium and your Medicare Advantage Plan premium. (Though some plans offer $0 premiums depending on where you’re located.) You’ll also save money by using doctors and other providers that are part of your plan’s provider network.

Do I need Medicare Part D prescription drug coverage if I have TRICARE?

TRICARE offers what’s considered “creditable coverage” – prescription drug coverage that exceeds the requirements by law. This means that you do not need to enroll in a Medicare Advantage plan with Part D coverage (MAPD), but you can still do so. If you enroll in TFL and an MAPD plan, both will pay their portion of your covered prescription drug costs. Just make sure the pharmacy that you use is included in both your MAPD plan’s network and participates with TRICARE.

Does TRICARE for Life work with Medigap plans?

It’s optional! TRICARE for Life is similar to a Medigap plan, but it is possible to enroll in Original Medicare, a Medigap plan, and TFL. Just keep in mind you’d need to pay both your Part B premium and your Medigap premium. 

Veterans with questions can always ask ApexHealth for help! Give us a call at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

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