TRICARE For Life is wonderful health insurance that’s for more than just for retired military personnel. It covers the gamut from:

• Uniformed service members and their families
• National Guard and Reserve members and their families
• Survivors
• Former spouses
• Medal of Honor recipients and their families, and
• Others registered in DEERS (Defense Enrollment Eligibility Reporting System)

TRICARE For Life is a Medicare wraparound for TRICARE, when one turns 65 or is on disability for 24+ months (immediately if they have ESRD or Lou Gehrig’s disease).

However, many do not understand how TRICARE For Life works with Medicare, other than it’s a wraparound and that they must have Medicare Parts A and B in order to be eligible. Myth has it that if a TRICARE For Life beneficiary takes Medicare Advantage, they will lose their TRICARE coverage. Not true. It enhances their coverage and helps to plug holes in benefits. How you ask? Let’s take a look.

Number 1: How TRICARE Works with Medicare

When you have TRICARE For Life and Original Medicare, you have three possible scenarios when you see a doctor:

1. If your service or procedure is covered by Original Medicare and TRICARE, Medicare is the primary payer. TRICARE pays any difference (typically any deductible and coinsurance Original Medicare does not pay). Remember, Original Medicare is an 80/20 Fee-For-Service plan with no MOOP (Maximum-Out-Of-Pocket) limit. Hence, without TRICARE, you would be stuck with the 20% balance and any deductible if you didn’t have a MediGap policy (a topic for another article).
2. If the procedure or service is covered by TRICARE only, you pay any TRICARE copay or deductible there may be.
3. If covered by Medicare only (a procedure not covered by TRICARE), you will pay Medicare’s deductible and 20% coinsurance (which can be substantial).

Medicare Comes in Different Forms

Notice that the beneficiary with Original Medicare and TRICARE did not lose his or her TRICARE coverage. Since you have the option of choosing how you wish to receive your Medicare benefits (Original Medicare or Medicare Advantage Part C), choosing a Medicare Advantage plan WILL NOT make you lose your TRICARE For Life coverage.

Now, with that said there are some changes that occur. Let’s look at these as well.

Medicare Advantage Becomes Primary

If you use your Medicare Advantage plan anywhere except at a military hospital or clinic (they do not accept Medicare, they only accept TRICARE or VA Benefits), it will be primary. Since it’s primary, if there are any copays, coinsurances or deductibles, you will be charged those. However, if it’s a fee TRICARE does NOT charge, you can submit form DD2642 (you can download it here) and TRICARE will reimburse you. Many medical practices are familiar with the process and will submit the form for you.

Now, you may think, “What if I’m hospitalized? That can be expensive! What if I don’t have the money to pay until I get reimbursed?” A valid concern. But keep in mind several things:

1. Hospitals don’t hand you a bill when you are discharged. You will receive a bill in the mail, typically 30+ days later.
2. You know what that bill will be because you have your Summary of Benefits. Your Summary of Benefits will tell you what your per diem copay is and for how many days. For example, you may have $125 per day, for the first four (4) days hospitalized. This equals $500.
3. Upon being discharged, file the form with the proof of hospitalization and length of stay. When you receive your reimbursement, pay the bill.