One of the best benefits of retiring and turning age 65 is TRICARE for Life. TRICARE for Life, or TFL for short, was enacted into law by Congress in the Fiscal Year 2001 National Defense Authorization Act (Public Law 106-398). TFL is Medicare-wraparound coverage if you are TRICARE-eligible and have Medicare Part A (inpatient care) and B (outpatient care), regardless of age or place of residence. It is not a Medicare Advantage plan but it acts like one. There are no enrollment fees.
Part B premiums. The key to TFL is that you must enroll in Medicare and pay Part B monthly premiums. Coverage is automatic starting on the first day that Medicare Parts A and B are in effect. Coverage is available worldwide, although Medicare is only good in the 50 U.S. States and its territories—Medicare is not valid in other overseas locations. TFL becomes the primary payer in overseas claims and co-pays apply. Once your spouse reaches age 65, they must also pay the Medicare Part B premium for TFL coverage.
ID Cards. There is no identification card for TFL. Generally you would use your Medicare identification card and your retiree ID card. You will need to obtain a new retiree ID card once you reach age 65 to reflect your Medicare eligibility. On the back of the retiree ID card, there is a beneficiary ID number and your DOD ID number—those numbers are what your provider will need to bill TFL for what Medicare doesn’t cover.
Providers. Speaking of providers, you can go to any provider that accepts Medicare. Providers that participate in Medicare and TRICARE agree to accept the Medicare determined reasonable and customary amount and may not bill you for the actual billed cost of the service. Referrals are not necessary. Once the provider files the claim for your office visit or procedure, Medicare will pay the claim first and then TFL will pay for covered services.
Claims. Medicare will provide you with an Explanation of Benefits that you can also access on the MyMedicare website. It will show how much Medicare allows and how much they paid. Then the claim is submitted to TFL (administered by Wisconsin Physicians Service, a TRICARE contractor) who pays what Medicare does not. For almost every claim, the two payments will add up to 100% of the allowable charges, and you will have no out-of-pocket costs (other than your monthly Medicare Part B premiums). You will have out-of-pocket costs if the treatment or procedure is not one covered by Medicare or TRICARE.
- MyMedicare: https://www.medicare.gov/account/login [800-772-1213]
- TFL/WPS: https://www.tricare4u.com/ (you will need to establish a DS LOGON account with DMDC to access this site) [866-773-0404]
- DMDC: https://myaccess.dmdc.osd.mil/identitymanagement/app/login [800-477-8227]
Using a MTF. You may also seek care at any military treatment facility at no cost on a space-available basis. TRICARE calls this TRICARE Plus. The local hospital commander makes the determination if you can participate and receive primary care at that military treatment facility. The authority is only good at that military treatment facility and no others. It will convey TRICARE Prime priority for treatment. The hospital commander may, at any time, disempanel the retiree and force you to receive your primary care in the civilian market. It does not guarantee access to specialty care within the military medical system.
Other Health Insurance. If you have other health insurance in addition to Medicare and TFL, such as coverage provided by your employer, the other health insurance pays first, Medicare pays second, and TFL pays third.
Other Medicare plans. Medicare Part C (Medicare Advantage plan) is not required under TFL. Neither is Medicare Part D (prescription coverage). In addition to retail pharmacies, you may use Express Scripts mail order pharmacy for maintenance medications, and you may also use military treatment facility pharmacies, where medicines are dispensed at no cost to the retiree.
Dental/Vision. As a retiree, generally TFL will not pay for dental care or vision care. TRICARE only covers glasses or contact lenses to treat certain conditions, like infantile glaucoma, for family members. However, if you’re a retiree, TRICARE will cover the cost of glasses or sunglasses needed for vision correction. For dental and vision care, you may want to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP) for coverage. Visit this webpage for more information: https://www.benefeds.com/. [877-888-3337]
Exclusions. In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including mental disorder), injury, or for the diagnosis and treatment of pregnancy or well-child care. TRICARE doesn’t cover services and supplies: from a scientific or medical study, grant or research program, provided for free, that would be free if you or your sponsor weren’t eligible for TRICARE. Additionally, all services and supplies (including inpatient institutional costs) related to a non-covered condition or treatment, or provided by an unauthorized provider, are excluded. For a list of exclusions, visit this webpage: https://www.tricare.mil/CoveredServices/IsItCovered/Exclusions
Click here for the TFL webpage: https://www.tricare.mil/Plans/HealthPlans/TFL
— EANGUS National Office
