The Basic Relationship Between Medicare and TRICARE for Life

TRICARE for Life is a health plan for military retirees, their spouses, and survivors who are also enrolled in Medicare Parts A and B. It works as a secondary payer, meaning Medicare processes your claim first, then TRICARE for Life covers costs Medicare does not pay. You must have both plans active at the same time for TRICARE for Life to work.

This is different from most Medicare supplement plans, which straightforward fill gaps in Medicare coverage. TRICARE for Life is tied directly to your military service record and requires you to maintain Medicare enrollment. If you drop Medicare Part A or Part B, you lose TRICARE for Life coverage when ready.

The combination typically results in very low out-of-pocket costs for covered services. Most preventive care is free, and you pay nothing for hospital stays once you meet Medicare's deductible. However, the rules about which providers you can see and how claims are processed differ from standard Medicare.

Key Takeaways

  • TRICARE for Life only works if you are enrolled in both Medicare Part A and Part B, and it pays second after Medicare processes your claim.
  • You must be a military retiree, survivor, or family member of someone with military service to be may be able to access, and you must be age 65 or older.
  • TRICARE for Life has no monthly premium, but you still pay Medicare Part B premiums and any applicable Medicare deductibles.
  • You can see any Medicare-approved provider without referrals, but using TRICARE network providers typically results in lower out-of-pocket costs.
  • Enrollment in TRICARE for Life happens through the Defense Enrollment may be able to access Reporting System (DEERS), not through Medicare or Social Security.

Who Can Enroll in TRICARE for Life

You must meet three conditions to enroll in TRICARE for Life. First, you must be age 65 or older. Second, you must be enrolled in Medicare Part A and Part B. Third, you must have military service or be a family member or survivor of someone with military service.

Military service includes active duty, Reserve, National Guard, and retired service members. Spouses and survivors of deceased service members also may have access to. If you were dishonorably discharged, you are not may be able to access. The military branch does not matter — Army, Navy, Air Force, Marine Corps, Coast Guard, and Space Force all may have access to.

You do not need to have served a minimum number of years, but you must have left the service under honorable conditions. If you are unsure about your may be able to access, you can check your status through DEERS or contact your local military treatment facility.

How the Two Plans Pay Together

When you receive care, Medicare processes the claim first. Medicare pays its share based on what it covers and what you have already paid toward your deductible. TRICARE for Life then receives the claim and pays a portion of what Medicare did not cover.

For example, if you see a doctor and the visit costs $150, Medicare might pay $120 after your deductible is met. TRICARE for Life would then pay the remaining $30. You pay nothing. If you have not met your Medicare deductible yet, the process is different: Medicare pays nothing, TRICARE for Life may pay part of the bill, and you pay the rest until the deductible is satisfied.

This coordination happens automatically when you use providers who accept both Medicare and TRICARE. The provider submits the claim to Medicare first, Medicare sends its payment and explanation of benefits to TRICARE for Life, and TRICARE for Life processes its portion. You typically receive one bill showing what each plan paid.

Out-of-network providers or those who do not accept TRICARE may require you to pay upfront and then file for reimbursement yourself. This is slower and more complicated, so using in-network providers is strongly recommended.

What TRICARE for Life Covers and Does Not Cover

TRICARE for Life covers the same services Medicare covers, since it only pays after Medicare has processed the claim. This includes hospital stays, doctor visits, preventive care, mental health services, and prescription drugs (if you also enroll in a Medicare Part D plan). Preventive services like annual wellness visits, cancer screenings, and vaccinations are covered with no cost-sharing.

TRICARE for Life does not cover services Medicare does not cover. This includes routine dental care, routine vision care, hearing aids, and long-term care or nursing home stays. Some mental health services have limits. If you need these services, you would need to pay out of pocket or purchase a separate plan.

Prescription drug coverage works through Medicare Part D, not through TRICARE for Life directly. You must enroll in a Part D plan during your initial enrollment period or during the annual open enrollment period. TRICARE for Life coordinates with Part D, so your total out-of-pocket costs for drugs are typically low.

Enrollment Steps and Timing

You enroll in TRICARE for Life through DEERS, the military's enrollment system, not through Medicare. You can enroll online at milconnect.dmdc.osd.mil or by visiting a military treatment facility, a TRICARE service center, or calling the TRICARE customer service line.

The best time to enroll is during your initial Medicare enrollment period, which begins three months before the month you turn 65. If you enroll in Medicare Part A and Part B during that window, you can enroll in TRICARE for Life at the same time. This prevents any gap in coverage.

If you miss your initial enrollment period, you can still enroll in TRICARE for Life at any time, as long as you are already enrolled in Medicare Parts A and B. There is no late enrollment penalty for TRICARE for Life itself, but you may face penalties if you delayed enrolling in Medicare Part B.

You will need your military ID or proof of military service, your Medicare card, and your Social Security number. If you are a spouse or survivor, you will also need documentation of your relationship to the service member.

Costs: Premiums, Deductibles, and Out-of-Pocket Limits

TRICARE for Life has no monthly premium. You do, however, continue to pay your Medicare Part B premium, which is deducted from your Social Security check each month. The amount varies based on your income.

You are responsible for Medicare's annual deductible for Part A (hospital insurance) and Part B (medical insurance). Once you meet these deductibles, TRICARE for Life typically covers the remaining costs. For hospital stays, you pay Medicare's Part A deductible once per benefit period, then nothing for the hospital stay itself.

For doctor visits and outpatient services, you pay Medicare's Part B deductible, then TRICARE for Life covers the rest. There is no separate TRICARE for Life deductible. Out-of-pocket costs are capped — once you reach a certain amount in a calendar year, both Medicare and TRICARE for Life cover services at no cost to you for the remainder of that year.

If you use out-of-network providers or providers who do not accept TRICARE, your costs will be higher. Some providers may balance-bill you for the difference between what they charge and what Medicare allows, though this is limited by law.

Using Providers and Getting Referrals

You can see any doctor or specialist who accepts Medicare without needing a referral. TRICARE for Life does not require referrals for specialist care the way some other health plans do. This gives you flexibility to see the providers you choose.

However, your costs are lowest when you use providers who are in the TRICARE network and who accept both Medicare and TRICARE. You can search for in-network providers on the TRICARE website or by calling TRICARE customer service. Military treatment facilities (hospitals and clinics on military bases) are also available to you at no cost if you are may be able to access to use them.

If you see a provider who does not accept TRICARE, you may have to pay the full bill upfront and then file a claim for reimbursement. This is more work and may result in higher out-of-pocket costs. Before scheduling an appointment, confirm that the provider accepts both Medicare and TRICARE.

Frequently Asked Questions

What happens to my TRICARE for Life if I drop Medicare Part B?

You lose TRICARE for Life coverage when ready. TRICARE for Life requires active enrollment in both Medicare Part A and Part B. If you drop Part B for any reason, you must re-enroll in both Medicare and TRICARE for Life during the next open enrollment period, and you may face late enrollment penalties.

Can I use TRICARE for Life at military hospitals and clinics?

Yes. Military treatment facilities are available to you at no cost if you are may be able to access. You do not need to use them — you can see any Medicare-approved provider instead. Many people use military facilities for routine care and Medicare providers for specialists or when a military facility is not convenient.

Do I need to enroll in a Medicare Part D plan if I have TRICARE for Life?

You should enroll in a Part D plan to cover prescription drugs. TRICARE for Life does not cover drugs directly. If you do not enroll in Part D when you first become may be able to access, you may face a late enrollment penalty that increases your premiums permanently.

What if I move out of state or overseas?

TRICARE for Life works nationwide and in some overseas locations. If you move, your coverage continues as long as you remain enrolled in Medicare Parts A and B. Confirm with TRICARE customer service that your new location is covered, especially if you are moving overseas.

Can I have both TRICARE for Life and a Medigap plan?

No. You cannot enroll in a Medigap (Medicare supplement) plan if you have TRICARE for Life. TRICARE for Life serves the same purpose — it covers costs Medicare does not pay. Having both would create coordination problems and is not permitted.