How TRICARE works with Medicare

Beneficiaries eligible for both TRICARE and Medicare should understand how the two medical insurance programs work together. Medicare consists of a few different parts. If you’re familiar with these parts, you might be wondering how each works with TRICARE, and if additional supplemental insurance is necessary for those who are dual-enrolled in both Original Medicare and TRICARE.

TRICARE For Life (TFL) is the health insurance program available to U.S. military retirees who qualify, as well as their beneficiaries, for no cost. It’s different and separate from Medicare. Medicare is the U.S. national health insurance program for individuals 65 years of age and older or who are disabled. It’s crucial for those who are dual-eligible to understand their coverage options.

How Does TRICARE For Life Work with Original Medicare?

TRICARE-eligible beneficiaries will be automatically enrolled in TRICARE For Life when they sign up for both Part A and Part B. This means you don’t need to worry about enrollment forms.

You must pay your monthly Part B premium to remain enrolled. If you enroll in both Medicare and TFL, Medicare will be your primary insurance, and TFL will work as a wraparound.

TFL will help cover costs for which the beneficiary would otherwise be responsible to pay. This includes the Part A hospital deductible and Part B coinsurance.

When used together, TFL and Medicare will cover most procedures deemed medically necessary. It’s also important to know that TRICARE doesn’t issue insurance cards, unlike Medicare which issues its red, white, and blue card.

How Does TRICARE For Life Work with Medicare Advantage?

Some TRICARE For Life beneficiaries choose to enroll in Medicare Advantage plans (Medicare Part C) to access benefits such as gym memberships and dental, vision, and hearing coverage. As Medicare doesn’t cover these benefits, an Advantage plan is a means for the beneficiary to obtain them. Before you enroll in a Medicare Advantage plan, make sure your health care providers are in the plan network – meaning they accept your coverage.

For example, if you have a Medicare Advantage HMO plan and TFL, the HMO is your primary insurance, and TFL acts as a supplement. If you receive care outside your HMO network, the HMO won’t cover any of the costs. You may file a claim with TFL, but it will be up to TFL to decide to reimburse you for the costs since it was out of network. This is why it is important to stay in-network for non-emergency services when you have both a Medicare Advantage and TFL.

Anything the Advantage plan doesn’t cover, TFL will help to cover. This includes copays and deductibles, for which you would be otherwise responsible.

Therefore, if your providers are in your network, you may ultimately have no out-of-pocket expenses once TFL has paid its share. Thus, underscoring the importance of ensuring your providers are in-network before signing up for a Medicare Advantage plan.

You may also need to file a reimbursement claim with TFL if you doctors do not file it for you. This form is called DD Form 2642 and details regarding it can be found here: https://www.tricare.mil/PatientResources/Claims/MedicalClaims

You can view the claim form here: https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2642.pdf