Tricare for Life (TFL) acts as secondary insurance to Medicare for members of the military. The plan helps pay out-of-pocket healthcare costs, such as copays and coinsurance.
The TFL plan is not a Medicare Advantage plan, which is a primary health plan rather than secondary insurance. Tricare, the company that offers TFL, does not offer any Advantage plans.
This article discusses Tricare plans, including TFL. It also looks at Medicare Advantage plans. It then examines TFL costs, eligibility, and enrollment information. Lastly, it describes a TFL plan for military members who reside overseas.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The company offers many health plans, including Tricare Prime, Tricare Extra, and Tricare Standard. A person may use this online tool to find a plan that suits their needs.
However, the TFL plan is the option for people who are:
- Medicare-eligible uniformed services retirees aged 65 or older
- their eligible family members and survivors
- certain former spouses
- a person registered in the defense enrollment eligibility reporting system (DEERS)
- a Medal of Honor recipient or eligible family member
A person must also be enrolled in original Medicare (Part A and Part B) to get TFL.
The TFL plan works as a supplement to Medicare. When a person with the plan visits a doctor, the doctor’s office files the claim with Medicare. After Medicare processes the claim and pays its portion, the bill goes to TFL, which often pays the remaining costs.
In other words, Medicare is the primary-payer insurance, and TFL is the second-payer insurance.
Medicare Advantage (Part C) is an alternative to original Medicare (Part A and Part B). Private companies offer Advantage plans, which may include prescription drug coverage and other benefits such as dental and vision care.
Out-of-pocket costs of Advantage plans are different from those of original Medicare. Advantage plans also put an annual cap on yearly expenses.
A person enrolled in TFL can also get an Advantage plan. However, there are factors to consider, including:
- Both TFL and many Advantage plans offer prescription drug coverage. A person could therefore choose an Advantage plan that does not offer prescription drug coverage as the premium may be lower, though there may still be copays.
- A person may need to pay a copay if they visit an in-network doctor through an Advantage plan. However, TFL may cover the cost.
- The in-network provider list with an Advantage plan may be smaller than a similar list with either TFL or original Medicare.
TFL does not charge any monthly premiums, although a person has to pay the Medicare Part B monthly premium, which is $148.50 in 2021.
Medicare pays 80% of the out-of-pocket costs and TFL pays the remaining 20%, as well as the annual deductible, which in 2021 is $203. However, if a person goes to a healthcare provider who does not accept Medicare, they will pay 80% of the cost, and TFL pays the remaining 20%.
Because TFL covers prescription drugs, a person may have a copay charge but will not need to enroll in Medicare Part D (prescription drug coverage).
There are some services TLF does not cover, such as chiropractic care. For those services, Medicare pays 80%, and the person pays 20%. However, TFL covers most services that Medicare covers and the combination of Medicare and TFL may provide for most of a person’s healthcare needs.
There are two eligibility requirements for TFL. One relates to Medicare, and the other relates to the military. A person can check their eligibility online.
If a person is enrolled in original Medicare, they are eligible for TFL on the first day they have the coverage.
An individual with Medicare is eligible for TFL if they are in one of the following categories:
- a retired serviceperson
- a spouse or dependent of a retired serviceperson
- a survivor of a deceased spouse who was a serviceperson
- a Medal of Honor recipient or eligible family member
- a person registered in DEERS
- an eligible former spouse of a serviceperson
People do not need to fill out a form to enroll in TFL. If they are enrolled in original Medicare and registered in DEERS, they are automatically covered.
However, a person must have a valid military ID card, which must be renewed after it expires on the first day of the month that a person turns 65.
A person who gets benefits will be automatically enrolled by the Social Security Administration (SSA). A person can check their status by going to their local SSA office or calling 800-772-1213.
If a person delays enrollment in original Medicare, disenrolls from Medicare Part B, or stops paying Medicare Part B premiums, TFL suspends their coverage until they reenroll. Upon re-enrollment, a person will again automatically receive TFL benefits.
The TFL plan is available to eligible people across the United States and in its territories, including Puerto Rico and Guam. A person who lives overseas in non-U.S. territories that have an established military hospital may enroll in the Tricare Overseas Program (TOP) Tricare for Life.
Because Medicare is not available overseas, the TOP program functions as the primary insurer. People with the TOP plan must pay Tricare’s yearly deductible and cost sharing. They also are responsible for any fees that exceed the plan’s allowable charges.
Tricare for Life (TFL) is a health insurance supplement that pays most of the out-of-pocket costs associated with original Medicare. The company does not offer Advantage plans.
To get TFL benefits, a person must be enrolled in original Medicare and have military credentials, such as proof that they are a retired serviceperson or one of their dependents.
People with a TFL plan do not pay a monthly premium, but they must pay the Medicare Part B monthly premium.