Editor’s note: This article is the first in a two part series.
First, let’s look at what is meant by the terms TRICARE and TRICARE for Life (TFL).
- TRICARE is the basic health care program serving Uniformed Service members, retirees and their families worldwide who, under law, are enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). DEERS is a database of uniformed service members and their eligible family members maintained by the Department of Defense.
- TRICARE for Life (TFL) is TRICARE’s version of a Medicare supplemental plan. It’s commonly referred to as Medicare-wraparound coverage for Medicare-eligible TRICARE beneficiaries.
TFL is managed by the Department of Defense. Medicare is managed by the Centers for Medicare and Medicaid Services (CMS). The two agencies work together to coordinate benefits.
Generally speaking, a person who is eligible for TRICARE is also eligible for TRICARE for Life, with the exception that in order to continue their TRICARE eligibility when they retire or turn age 65, they MUST enroll in Medicare Parts A and B. Medicare Part A is generally premium free. Medicare Part B has a monthly premium, currently starting at $99.90 per month in 2012. For now, TFL has no monthly premium. However, as with all federal benefits, they are not immune to the whims of Congress.
With TFL, Medicare becomes the primary insurance carrier, and TFL is secondary. In effect, TFL beneficiaries become Medicare patients. Neither TFL nor the Department of Defense issue any separate TFL insurance identification cards to individuals or family members. However, some knowledgeable health care providers may ask for a military ID card.
Because CMS coordinates benefits with TFL, the health care provider simply bills Medicare, who then passes on the remainder to TFL. Medicare pays 80% of approved amounts for Medicare-covered services to providers who accept Medicare assignment. Tricare will pay the Medicare deductible and co-pays/coinsurance for Tricare-covered services. If the healthcare provider does not accept Medicare assignment, Tricare pays up to 15% over the Medicare approved amount.
Generally speaking with Tricare as the secondary payer, the TFL enrollee (and eligible family members) will have virtually no out-of-pocket expenses.
In Part II, we’ll discuss those folks who work for the federal government and the postal service who may be dually eligible for TRICARE and the Federal Employees Health Benefits (FEHB) program.