Four reminders about getting care with TRICARE For Life

SFL Logo April 2, 2024

FALLS CHURCH, Va. – Whether you’re new to TRICARE For Life (TFL) or you’ve had it for years, you may have questions about getting care with TFL. 
 
TFL is Medicare-wraparound coverage for military retirees and their family members who are TRICARE-eligible and have Medicare Part A and Part B. Medicare is your primary health coverage when you have TFL. 
 
“This means that Medicare pays first on a health care claim,” said Anne Breslin, TRICARE For Life program manager. “TRICARE pays second, or last if you have other health insurance.” 
 
Knowing how Medicare coverage works can help you avoid unexpected costs. Read on to learn tips for getting care with Medicare. 

1. Know where you can use Medicare 

Medicare provides coverage in the U.S. and U.S. territories. It also covers health care services you get on ships in U.S. territorial waters. 
 
Medicare doesn’t cover care in all other overseas locations. TFL is your primary health coverage in these locations, unless you have other health insurance (OHI). Remember, if you’re eligible for Medicare, you must have Medicare Part A and Part B to have TFL. This is regardless of your age or if you live overseas. 
 
Are you eligible for both TFL and U.S. Department of Veterans Affairs (VA) benefits? If you need health care unrelated to your military service, you should see a civilian Medicare provider. That’s because VA providers can’t bill Medicare. If you see a VA provider to get care not related to a service-connected injury or illness: 

  • You may have significant out-of-pocket costs. 
  • By law, TRICARE can only pay up to 20% of the TRICARE-allowable amount. 

2. Know your provider options and their costs 

Most TFL beneficiaries get care from civilian Medicare providers. The TRICARE For Life Handbook describes the three types of civilian providers you can see in the U.S. and U.S. territories: 

  • Medicare participating providers agree to accept the Medicare-approved amount as payment in full. 
  • Medicare non-participating providers don’t accept the Medicare-approved amount as payment in full. These providers may charge up to 15% above the Medicare-approved amount. TRICARE covers this extra cost. 
  • Opt-out providers don’t participate with Medicare and can’t bill Medicare. Medicare won’t pay for care you get from these providers. TFL will pay up to 20% of the TRICARE-allowable charge for TRICARE covered services. You’re responsible for the rest of the TRICARE-allowable charge. 

The Medicare Provider Directory can help you find providers and hospitals that take Medicare. Before you get care, call your provider to confirm they take Medicare. 
 
You can also get care at a military hospital or clinic, if space is available. 
 
Overseas, you can use any TRICARE-authorized civilian provider. In the Philippines, you must see a certified provider. 

3. Know what Medicare and TRICARE cover 

Medicare and TRICARE cover many of the same health care services. However, some services may be covered only by Medicare, only by TRICARE, or by neither. 
 
Before you get care, see what Medicare covers and what TRICARE covers. Generally, you’ll have lower out-of-pocket costs when you follow Medicare’s rules for getting care. 
 
See the TRICARE For Life Cost Matrix to learn how Medicare and TRICARE coordinate benefits to limit your out-of-pocket expenses. 

4. Know how Medicare Advantage Plans work 

“Medicare Part C” refers to Medicare Advantage Plans. Private companies contract with Medicare to offer these plans. Coverage includes Medicare Part A and Part B. 
 
You don’t need Medicare Part C to have TFL coverage. But if you choose to sign up for a Medicare Advantage Plan, keep the following in mind: 

  • You must get all nonemergency health care from that plan’s provider network. 
  • Your plan may require pre-authorization for health care services. 
  • You may pay a monthly premium in addition to your Medicare Part B premium. 
  • You may have copayments at the time of service. You may need to file paper claims with the TFL contractor, Wisconsin Physicians Service (WPS), to be reimbursed for these copayments. 

 
What if you sign up for a Medicare Advantage Plan and later decide you’d rather use Original Medicare? Because you have TFL, you may disenroll from a Medicare Advantage Plan at any time. You can call Medicare or your Medicare Advantage Plan or to request disenrollment. You’ll automatically be back in Original Medicare. 
 
Do you still have questions about your TFL coverage? For care in the U.S. and U.S. territories, call WPS at 866-773-0404. You can also call WPS to request a copy of the TRICARE For Life Handbook. If you’re traveling or living overseas, call your TRICARE Overseas regional call center. 

Article Source: 4 Reminders About Getting Care With TRICARE For Life