What Medicare and TRICARE for Life Actually Cover Together

Medicare and TRICARE for Life together cover more than either one alone, but they do not cover everything. TRICARE for Life is a secondary insurance for military retirees and their spouses who are 65 or older and enrolled in Medicare Part A and Part B. When both are active, TRICARE for Life pays many of the costs that Medicare does not — copayments, coinsurance, and deductibles. However, gaps remain in areas like dental care, vision care, hearing aids, and long-term care.

The way they work together matters. Medicare pays first for covered services. TRICARE for Life then pays its share of what Medicare approved, up to what Medicare would have paid. This coordination means you are rarely responsible for the full cost of a covered service, but you may still owe money for services Medicare does not cover at all.

Your out-of-pocket costs depend on which services you use and where you receive them. Using a TRICARE-authorized provider usually means lower costs. Using an out-of-network provider may leave you with larger bills, even with both insurances active.

Key Takeaways

  • TRICARE for Life covers most Medicare copayments and deductibles but does not cover services that Medicare itself does not cover.
  • Dental, vision, hearing, and long-term care are not covered by Medicare or TRICARE for Life, and you will need separate insurance or out-of-pocket payment for these services.
  • Prescription drug coverage requires a separate Medicare Part D plan; TRICARE for Life does not include prescription drug coverage.
  • Out-of-network providers may bill you directly for amounts above what Medicare approves, even with both insurances in place.
  • Supplemental insurance (Medigap) cannot be used alongside TRICARE for Life, so you must choose one or the other.

The Services That Neither Plan Covers

Medicare and TRICARE for Life have the same coverage limits. If Medicare does not cover a service, TRICARE for Life will not either. The largest gaps are in routine dental care, routine vision care, and hearing aids.

Dental work — cleanings, fillings, root canals, extractions, and dentures — is not covered by either plan. You can purchase a separate dental plan, pay out of pocket, or use a dental discount program. Costs vary widely by location and provider, so getting estimates from multiple dentists is worth the time.

Vision care for glasses and contact lenses is also not covered. Medicare covers one eye exam every two years if you have diabetes or a history of glaucoma, but routine eye exams and corrective lenses are your responsibility. Hearing aids are not covered by Medicare or TRICARE for Life. A single hearing aid can cost $1,000 to $6,000, and most people need two. Some states offer hearing aid programs for seniors with low income; your state health department can tell you whether one exists where you live.

Long-term care — whether in a nursing home, assisted living facility, or at home — is not covered by Medicare or TRICARE for Life. Medicare covers skilled nursing care only after a hospital stay of at least three days and only for a limited time. If you need custodial care (help with daily activities rather than medical treatment), you pay out of pocket unless you have a long-term care insurance policy purchased before you turned 65.

Prescription Drugs and What You Pay

TRICARE for Life does not include prescription drug coverage. You must enroll in a separate Medicare Part D plan to have insurance for medications. If you do not enroll in Part D when you first become may be able to access, you will pay a penalty for each month you go without coverage, even if you enroll later.

Part D plans vary in which drugs they cover and how much you pay. Some medications are covered with a small copayment; others require you to pay more or use a different drug. Your costs depend on which plan you choose and which pharmacy you use. You can change your Part D plan once per year during the annual enrollment period (October 15 to December 7).

If you use the VA for health care as well as TRICARE, the VA covers your medications through the VA system. You do not need Part D if you receive all your care through the VA, but you still must enroll in Part D or pay the penalty, even if you do not use it.

Out-of-Network Providers and Balance Billing

Using an in-network provider is important because it limits what you owe. When you see a provider who has agreed to accept Medicare and TRICARE rates, they cannot bill you for more than the approved amount. TRICARE for Life then pays its share, and you pay the rest.

Out-of-network providers can bill you for the difference between what they charge and what Medicare approves. This is called balance billing. Even though TRICARE for Life is secondary insurance, it does not protect you from balance billing by out-of-network providers. Before scheduling with an out-of-network provider, ask them directly whether they accept Medicare assignment (meaning they agree to accept the Medicare-approved amount as full payment).

Emergency care is an exception. If you need emergency treatment and the nearest hospital or emergency room is out of network, you are protected from balance billing. However, you may still receive bills from individual doctors (radiologists, anesthesiologists, emergency physicians) who work at that hospital but are not employed by it. These doctors can balance bill you even in an emergency.

When TRICARE for Life Alone Is Not Enough

TRICARE for Life works well for routine medical care, hospital stays, and specialist visits covered by Medicare. It is less helpful if you have chronic conditions that require frequent dental work, need hearing aids, or are at risk of needing long-term care.

If you have significant dental needs, budgeting $1,000 to $3,000 per year for dental care is realistic. A dental discount plan (not insurance) costs $80 to $200 per year and gives you discounts at participating dentists, typically 10 to 60 percent off standard fees. These plans have no waiting period and no exclusions for pre-existing conditions.

For hearing aids, some TRICARE regions offer limited coverage through the VA if you are a veteran. Ask your TRICARE representative whether you may have access to. If not, hearing aid costs are entirely out of pocket unless you have a separate policy.

For long-term care, most people either pay out of pocket when the time comes or rely on Medicaid after spending down their savings. Long-term care insurance is expensive and must be purchased before age 65 to be affordable. If you are already 65 or older, long-term care insurance is rarely available or is very costly.

Comparing Your Options: Staying with TRICARE for Life or Switching

You cannot use TRICARE for Life and a Medigap (supplemental) plan at the same time. If you are considering switching away from TRICARE for Life, you need to understand what you would gain and lose.

A Medigap plan covers some of the costs that Medicare does not, such as copayments and coinsurance. However, Medigap plans also do not cover dental, vision, hearing, or long-term care. The main difference is that Medigap plans often cover more of the copayments and deductibles than TRICARE for Life does, and some Medigap plans cover services abroad (which TRICARE for Life does not).

If you leave TRICARE for Life, you cannot return to it later. This is a permanent decision. Before switching, compare the monthly premiums, annual deductibles, and copayments of a Medigap plan with what you currently pay under TRICARE for Life. Also consider whether you use VA care or TRICARE providers — switching away from TRICARE for Life may limit your options.

Questions to Ask Your Doctor and TRICARE

Before starting a new treatment or medication, ask your doctor whether it is covered by Medicare. If it is not, ask whether there is a covered alternative. Ask your TRICARE representative whether the specific service is covered and what your out-of-pocket cost will be.

If you are considering a procedure that is expensive or unusual, ask your doctor to submit a pre-authorization request to TRICARE. This tells you in advance whether TRICARE will pay and what you will owe. Do not assume that because a service is medically necessary, it is covered.

For any service not covered by Medicare or TRICARE for Life, ask your provider for a written estimate of the cost. Get estimates from multiple providers if possible. Ask whether they offer payment plans or discounts for paying in full upfront.

Frequently Asked Questions

Does TRICARE for Life cover dental work?

No. Neither Medicare nor TRICARE for Life covers routine dental care, fillings, root canals, extractions, or dentures. You will need a separate dental plan or pay out of pocket. Some dental discount plans cost $80 to $200 per year and offer discounts at participating dentists.

What happens if I do not enroll in Medicare Part D?

You will pay a penalty for each month you go without Part D coverage, even if you enroll later. The penalty is added to your Part D premium for as long as you have the plan. You must enroll during the annual enrollment period (October 15 to December 7) or during a special enrollment period if you have a may have access to life event.

Can I use a Medigap plan instead of TRICARE for Life?

You cannot use both at the same time. If you switch to a Medigap plan, you cannot return to TRICARE for Life later. Before switching, compare the costs and coverage carefully. TRICARE for Life is usually less expensive, but a Medigap plan may cover more of your copayments and deductibles.

What if my doctor is out of network?

Ask your doctor whether they accept Medicare assignment (meaning they agree to accept the Medicare-approved amount as full payment). If they do not, they can bill you for the difference between what they charge and what Medicare approves, even with TRICARE for Life as secondary insurance.

Does TRICARE for Life cover hearing aids?

No. Hearing aids are not covered by Medicare or TRICARE for Life. If you are a veteran, ask your TRICARE representative whether the VA offers hearing aid coverage in your region. Otherwise, hearing aid costs are entirely out of pocket, typically $1,000 to $6,000 per aid.