Tricare and Medicare
In this post, we explain how Tricare and Medicare work together to provide coverage for those who qualify.
What is Tricare
Tricare is a healthcare program available to active-duty service members, active-duty family members, National Guard and Reserve members and family members. It is also available to retired service members and their families, survivors, and some former spouses. This program combines military healthcare resources (military hospitals & clinics) with civilian healthcare professionals to provide services to its members.
It is helpful for anyone eligible for both Tricare and Medicare to know how these benefits work together. Tricare For Life (TFL) is provided free of charge to U.S. military retirees and their qualified beneficiaries. Medicare coverage is a separate program available to beneficiaries 65 or older as well as qualified disabled individuals.
TFL and original Medicare
Beneficiaries who are eligible for TFL, are automatically enrolled in TFL when they sign up for Medicare Part A and Part B. There is no need to fill out any enrollment forms. TFL beneficiaries must remain enrolled in Medicare Part B to maintain TFL enrollment. Medicare is the primary insurer for those enrolled in Medicare and TFL. In this case, TFL is the secondary insurer and covers costs the beneficiary would normally be left to pay. It covers the Part A deductible as well as Part B co-insurance costs.
Please note: Tricare does not provide insurance cards. Military members should register in DEERS (Defense Enrollment Eligibility Reporting System) database to receive Tricare. DEERS is a database of information on uniformed services members and their family members (sponsors), Once you register for DEERS, you receive a Uniformed Services ID card. Is important to make sure your coverage information is up to date in the DEERS system to avoid problems with your health care benefits.
Members can also access proof of their coverage through milConnect, a website that provides military members with benefit information for insurance, including help finding a provider, proof of coverage, GI benefits and much more.
TFL with Medicare supplements (Medigap)
TFL coverage is similar to a Medicare Supplement plan. Beneficiaries of TFL are eligible to enroll in a Medicare Supplement plan as long as they have both Medicare Part A & Part B. Enrollment in a Medicare supplement is not free and may not be necessary for members of TFL plans. It is best to consider all medical and financial needs before deciding on plan coverage choices. Beneficiaries who elect to enroll in Medicare, Medicare supplements and TFL have Medicare as the primary coverage, the Medicare supplement is secondary and the TFL pays after both the other options.
TFL and Medicare advantage
When TFL beneficiaries opt to enroll in Medicare Advantage (Medicare Part C) coverage, the Medicare advantage plan acts as the primary insurer. The TFL coverage is considered supplemental and will help cover costs for deductibles and co-pays as well as medically necessary out-of-network services.
It is always a good idea to be sure any providers the beneficiary uses are in-network with the MA/MAPD plan chosen. If the providers are in network, beneficiaries could end up not having to pay any out-of-pocket costs after TFL pays its share.
Learn about the pros & cons of Medicare advantage plans
Medicare Part D and TFL
Because TFL provides prescription drug coverage, beneficiaries do not need to enroll in Medicare Part D prescription drug coverage. TFL prescription coverage qualifies as creditable coverage. This means, if you decide to enroll in Part D later on, you will not receive a LEP (late enrollment penalty) from Medicare.
It is important to note, TFL members must fill maintenance drug prescriptions like, blood pressure or cholesterol, through Tricare’s mail order pharmacy. TFL members can fill other prescriptions at any pharmacy they choose. The beneficiary is responsible for any co-pays.
Tricare Prime and Medicare
Beneficiaries under age 65 who have Medicare and Tricare Prime, can remain on Tricare Prime for as long as they are eligible. Members receive a waiver for Prime enrollment fees or a refund for a prior enrollment fee.
Tricare Plus and Medicare
Tricare Plus provides beneficiaries a way to receive primary care in military hospitals or clinics. It is important to make sure the military facility accepts Tricare Plus before receiving care. To be part of this program, members must enroll.
The benefits provided by Tricare Plus are similar to Tricare Prime. They both work the same as regular Tricare in regard to Medicare because it is still primary coverage. It is important to confirm the military facility accepts Tricare Plus before scheduling care. Tricare Plus is for Tricare eligible individuals not enrolled in Tricare Prime.