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TRICARE For Life TRICARE provides Medicare-wraparound coverage for Medicare-eligible beneficiariesTRICARE For Life (TFL) is Medicarewraparound coverage for TRICARE beneficiarieswho have Medicare Part A and Medicare Part B,regardless of age or place of residence. With TFL,you have the freedom to seek care from anyMedicare-participating or nonparticipatingprovider, or military hospital or clinic on aspace-available basis. Medicare-participatingproviders file your claims with Medicare. Afterpaying its portion, Medicare automaticallyforwards the claim to TRICARE for processing(unless you have other health insurance [OHI]).TRICARE pays after Medicare and OHI forTRICARE-covered health care services.ELIGIBILITYAs a TRICARE beneficiary, you are eligible forTFL on the first date that you have both MedicarePart A and Part B.When you are entitled to premium-freeMedicare Part A: Medicare Part B coverage is required to remainTRICARE-eligible if you are a: Retired service member (including retiredNational Guard and Reserve membersdrawing retirement pay) Family member of a retired service member Medal of Honor recipient or eligiblefamily member Survivor of a deceased sponsor Qualifying former spouse Medicare Part B coverage is not required toremain TRICARE-eligible if: You are an active duty service member (ADSM)or active duty family member (ADFM)(ADSMs and ADFMs remain eligible forTRICARE Prime and TRICARE Standardand TRICARE Extra options while the sponsoris on active duty. However, when the sponsorretires, you must have Medicare Part B toremain TRICARE-eligible. See “MedicarePart B [Medical Insurance]” on the followingpage for information about the MedicarePart B special enrollment period for ADSMsand ADFMs.) You are enrolled in TRICARE Reserve Select(TRS), TRICARE Retired Reserve (TRR),or the US Family Health Plan (USFHP)(While you are not required to have MedicarePart B to remain eligible for TRS, TRR, orUSFHP, you are strongly encouraged to signup for Medicare Part B when first eligible toavoid paying a premium surcharge if youenroll at a later date.)This fact sheet is not all-inclusive. For additional information, please visit www.tricare.mil.October 2013

Note: Regardless of age, ADFMs who haveMedicare Part A may enroll in TRICARE Primeif they live in a TRICARE Prime Service Area.The TRICARE Prime enrollment fee is waivedfor any TRICARE Prime enrollee who hasMedicare Part B, regardless of age.when first eligible at age 65 to avoid paying alate enrollment surcharge. You should then filefor Part A benefits under your spouse’s recordtwo months before he or she turns 62.Note: If neither spouse will be eligible forpremium-free Medicare Part A, neither will needMedicare Part B to remain TRICARE-eligible.UNDERSTANDING MEDICAREMedicare Part B (Medical Insurance)TFL is managed by the Department of Defense(DoD). Medicare is managed by the Centers forMedicare & Medicaid Services (CMS). The twoagencies work together to coordinate benefits.Medicare is a federal entitlement health insuranceprogram for people:Medicare Part B covers provider services,outpatient care, home health care, durable medicalequipment, and some preventive services. MedicarePart B has a monthly premium, which may changeannually and varies based on income. If yousign up after your initial enrollment period forMedicare Part B, you may have to pay a monthlypremium surcharge for as long as you haveMedicare Part B. For specific information aboutyour Part B premium amount and/or surchargeamount, contact the SSA at 1-800-772-1213. Age 65 or older Under age 65 with certain disabilities Any age with end-stage renal disease (ESRD)Medicare Part A (Hospital Insurance)Medicare Part A covers inpatient hospital care,hospice care, inpatient skilled nursing facilitycare, and some home health care. The SocialSecurity Administration (SSA) determines yourentitlement to Medicare Part A based on yourwork history or your spouse’s (this includesformer or deceased spouses) work history. Youare eligible for premium-free Medicare Part A atage 65 if you or your spouse has 40 quarters or10 years of Social Security-covered employment.Medicare allows ADSMs and ADFMs who areentitled to Medicare based on age or disability(does not apply to those with ESRD) to delayPart B enrollment and sign up during a specialenrollment period, which waives the lateenrollment surcharge. The special enrollmentperiod for ADSMs and ADFMs is availableanytime the sponsor is on active duty or withinthe first eight months following either (1) themonth your sponsor’s active duty status endsor (2) the month TRICARE coverage ends,whichever comes first. To avoid a break inTRICARE coverage, ADSMs and ADFMsmust sign up for Medicare Part B before theirsponsor’s active duty status ends.If you are not entitled to premium-free MedicarePart A when you turn 65 under your own SocialSecurity number (SSN) but your spouse is, youmust file for benefits under your spouse’s (thisincludes divorced or deceased spouses) SSNif he or she is 62 or older. If your spouse is notyet 62 and you anticipate that he or she will beeligible for premium-free Medicare Part A atage 65, you should sign up for Medicare Part BNote: ADSMs and ADFMs with ESRD do nothave a special enrollment period, and should enrollin Medicare Part A and Part B when first eligible.2

Medicare Entitlement Based ona Disabilityyou are strongly encouraged to have MedicarePart B. ADSMs and ADFMs with ESRD do nothave a special enrollment period and, therefore,should enroll in Part B when first eligible to avoidthe Part B late enrollment surcharge. If you areenrolled in USFHP and entitled to Medicare basedon disability or age, you are not required to haveMedicare Part B; however, you are encouragedto sign up for Part B when first eligible to avoidthe Part B premium surcharge for late enrollment.If you receive Social Security disability benefits,you are entitled to Medicare in the 25th month ofreceiving disability payments. CMS will notifyyou of your Medicare entitlement date.If you have ALS (also called Lou Gehrig’sdisease), you automatically get Part A andPart B the month your disability benefits begin.If you have been diagnosed with an asbestosrelated disease (e.g., mesothelioma) and lived inLincoln County, Montana, for a total of at leastsix months during a period ending 10 years ormore before the diagnosis, you are eligible forMedicare. Your Medicare coverage will beeffective the month after you sign up.Depending on your sponsor’s status and yourTRICARE program option when you first becomeeligible for Medicare Part A based on ESRD,you may have to sign up for Part B to remainTRICARE-eligible and to avoid the Part B lateenrollment surcharge.If you return to work and your Social Securitydisability payments are suspended, yourMedicare entitlement continues for up to eightyears and six months. When your disabilitypayments are suspended, you will receive a billevery three months for your Medicare Part Bpremiums. You must continue to pay yourMedicare Part B premiums to remain eligiblefor TRICARE coverage.HOW TFL WORKS WITH MEDICAREIf you do not enroll in Part B when you firstbecome eligible, you may be required to pay apremium surcharge for each 12-month period thatyou were eligible to enroll in Part B, but did not.Medicare and TFL work together to minimizeyour out-of-pocket expenses. However, there areinstances when some health care costs may notbe covered by Medicare and/or TFL.Depending on your sponsor’s status and yourTRICARE program option when you first becomeeligible for Medicare Part A based on disability,you may have to sign up for Part B to remainTRICARE-eligible and to avoid the Part B lateenrollment surcharge.Medical Services Covered by Medicareand TRICAREWhen you see a participating or nonparticipatingMedicare provider, you have no out-of-pocket costsfor services covered by both Medicare and TFL.Most health care services fall into this category.After Medicare pays its portion of the claim, TFLpays the remaining amount, and you pay nothing.Medicare Entitlement Based on ESRDIf you are eligible for Medicare benefits based onESRD, you should sign up for Medicare Part Aand Part B when you are first eligible in orderto remain TRICARE-eligible. If you are aUSFHP enrollee under age 65 and are entitled topremium-free Medicare Part A based on ESRD,As the primary payer, Medicare approves healthcare services for payment. If Medicare does notpay because it determines that the care is notmedically necessary, TFL also does not pay.3

You may appeal Medicare’s decision and, ifMedicare reconsiders and provides coverage,TFL also reconsiders coverage.and you are responsible for the remainder ofthe billed charges. This includes care receivedfrom the Department of Veterans Affairs (VA)providers, who are not Medicare providers andcannot bill Medicare. For more information, seethe “TFL and VA” section of this fact sheet.If a health care service is covered by both Medicareand TFL, but Medicare does not pay because youhave used up your Medicare benefit, TFL becomesthe primary payer. In this case, you are responsiblefor your TFL deductible and cost-shares.Opt-out providers establish private contracts withpatients. Under a private contract, there are nolimits on what the provider can charge for healthcare services.If a health care service is normally covered by bothMedicare and TFL, but you receive the servicefrom a provider who has opted out of Medicare,the provider cannot bill Medicare and, therefore,Medicare will pay nothing. When you see anopt-out provider, TFL will process the claim asthe second payer, unless you have OHI. TFLpays the amount it would have paid if Medicarehad processed the claim (normally TFL pays20 percent of the TRICARE-allowable charge)Medical Services Covered by Medicarebut Not by TRICAREWhen you receive care that is covered byMedicare only (e.g., chiropractic care), Medicareprocesses the claim as the primary payer. TFLmakes no payment, regardless of any actionMedicare takes. You are responsible for theMedicare deductible and cost-shares.TRICARE For Life Out-Of-Pocket CostsType of ServiceWhat Medicare Pays What TRICARE Pays What You PayCovered by TRICARE Medicare’s authorizedand d byMedicare onlyMedicare’s authorizedamountNothingMedicare deductibleand cost-shareCovered byTRICARE onlyNothingTRICARE-allowableamountTRICARE deductibleand cost-shareNot Covered byTRICARE orMedicareNothingNothingBilled charges(which may exceed theMedicare- or TRICAREallowable amount)4