TRICARE For Life (TFL) is Medicare-wraparound coverage for “dual-eligible” TRICARE beneficiaries. Regardless of age, beneficiaries are considered dual-eligible if they are entitled to premium-free Medicare Part A and eligible for TRICARE because they also have Medicare Part B coverage. TFL provides comprehensive health care coverage. Beneficiaries have the freedom to seek care from any Medicare-participating, non-participating, or opt-out provider, at MTFs on a space-available basis, or at Veterans Affairs (VA) facilities (if eligible). Medicare cannot pay for services received from VA. Therefore, TRICARE is the primary payer for VA claims, and the beneficiary will be responsible for the TRICARE annual deductible and cost-shares. Alternatively, the beneficiary may choose to use his or her VA benefit.Note:
Neither TRICARE nor Medicare will reimburse costs not covered by the VA.
Medicare-participating providers file claims with Medicare first. After paying its portion, Medicare automatically forwards the claim to TFL for processing (unless the beneficiary has OHI). TFL pays after Medicare and any other health insurance for covered health care services. For more information, see Balance Billing
and Clearly Legible Reports
in the Important Provider Information
section of this handbook.
The term “dual-eligible” refers to TRICARE and Medicare dual eligibility and should not be confused with Medicare-Medicaid “dual-eligible.”Note:
Dependent parents and parents-in-law are not eligible for TFL, but may be eligible for space-available care at an MTF.
Some beneficiaries entitled to premium-free Medicare Part A, including ADSMs, ADFMs, and beneficiaries with TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR), Continued Health Care Benefit Program (CHCBP), and US Family Health Plan (USFHP), may keep their current TRICARE benefits without Medicare Part B coverage. Medicare allows certain beneficiaries, including ADSMs and ADFMs, to sign up for Medicare Part B during a special enrollment period, which waives monthly Part B late-enrollment premium surcharges. The special enrollment period does not apply to beneficiaries entitled to Medicare based on end stage renal disease. These beneficiaries are encouraged to sign up for Medicare Part B when first eligible to avoid the Medicare Part B late-enrollment premium surcharge. However, all beneficiaries are strongly encouraged to sign up for Medicare Part B as soon as they become eligible to avoid a break in TRICARE coverage and Medicare monthly late-enrollment premium surcharges.
TFL beneficiaries must present valid uniformed services identification (ID) cards and Medicare cards prior to receiving services. If a TFL beneficiary’s uniformed services ID card reads NO under the CIVILIAN box, he or she is still eligible to use TFL if he or she has both Medicare Part A and Part B. Copy both sides of the cards and retain the copies for files. There is no separate TFL enrollment card. To verify TFL eligibility, call the TFL contractor, Wisconsin Physicians Service (WPS)/TFL (WPS/TFL) at 1-866-773-0404. Call the Social Security Administration (SSA) at 1-800-772-1213 to confirm a patient’s Medicare status.
Beneficiaries age 65 and older who are not eligible for premium-free Medicare Part A may remain eligible for TRICARE Prime (if residing in PSAs) or TRICARE Standard and TRICARE Extra.
Refer to “TRICARE and Medicare Eligibility” in the TRICARE Eligibility
section of this handbook for more information.
How TRICARE For Life Works
Because Medicare is the primary payer, referrals and prior authorizations from Humana Military are usually not required. However, dual-eligible beneficiaries may need an authorization from Humana Military/ValueOptions if Medicare benefits are exhausted or for care covered by TRICARE but not Medicare. See the Health Care Management and Administration section of this handbook for more information about TRICARE referral and authorization requirements.
File TFL claims first with Medicare. Medicare pays its portion and electronically forwards the claim to WPS/TFL (unless the beneficiary has OHI). WPS/TFL sends its payment for TRICARE-covered services directly to the provider. Beneficiaries receive Medicare Summary Notices and TRICARE explanations of benefits indicating the amounts paid:
- For services covered by both TRICARE and Medicare, Medicare pays first, and TRICARE pays its share of the remaining expenses second (unless the beneficiary has OHI).
- For services covered by TRICARE but not by Medicare, TRICARE processes the claim as the primary payer. The beneficiary is responsible for the applicable TFL deductible and cost-share.
- For services covered by Medicare but not by TRICARE, Medicare is the primary payer, and TRICARE pays nothing. The beneficiary is responsible for the applicable Medicare deductible and cost-share.
- For services not covered by Medicare or TRICARE, the beneficiary is responsible for the entire bill.
See the Claims Processing and Billing Information section of this handbook for information about TFL claims and coordinating with OHI. For more information about TFL, call WPS/TFL at 1-866-773-0404 or visit the TRICARE4U
Back to Top