How Does Medicare Work with Tricare? 

TRICARE is a government health care program that covers health benefits for military personnel in the U.S. Armed Forces, those who have retired from the military, and the dependents of military personnel and retirees.  

You may be eligible for TRICARE enrollment if you are:

• A uniformed service member or a dependent of one 
• In the U.S. Army, Air National Guard or Reserve, or are a dependent of someone who is 
• A survivor of a deceased eligible sponsor
• The former spouse of an eligible sponsor
• A Medal of Honor recipient or a family member of one
• Registered in the Defense Enrollment Eligibility Reporting System (DEERS) 

You can be active duty, retired, a Guard or Reserve member, or a registered family member of any of the categories mentioned above to meet eligibility for TRICARE. 

Available TRICARE plans include TRICARE Prime, TRICARE Extra, TRICARE Standard, and TRICARE for Life (TFL). TFLis the TRICARE plan that’s available for uniformed service retirees who are 65 years or older and eligible for enrollment in Medicare. TFL is also available for eligible family members, survivors, some former spouses, those registered in the DEERS, Medal of Honor recipients, and eligible family members. If you’re eligible for TFL and Medicare, you should get to know more about how TRICARE and Medicare insurance works together to cover your health care needs. 

How does Medicare work with TRICARE? 

When you enroll in Medicare but also have coverage with TFL, Medicare becomes your primary insurance payer and TFL becomes the secondary payer. This means that Medicare first pays its share of expenses for any covered medical services you have, and if anything is left after this coverage, TFL pays its share.

In other words, a Medicare-affiliated physician or health care provider you visit files the claim for your care with Medicare. After paying its share, Medicare sends the claim (if there are unresolved charges) to TFL and they pay the remaining costs. With both Medicare and TFL coverage, you are still responsible for paying your Medicare Part B monthly premium. As of 2023, the premium is $164.90 for Part B, but TFL doesn’t carry a monthly premium.  

How does TFL work with Medicare Advantage? 

If you are enrolled in a Medicare Advantage (MA) plan at the same time you have TFL coverage, your MA coverage pays first and TFL second. You must also cover your MA coinsurance for any medical services. 

With Medicare Advantage coverage, you are responsible for filing a claim with TFL yourself after your Medicare Advantage provider processes the claim and you’ve covered your cost-share expenses. 

If you are eligible for TFL and Medicare, you can choose to enroll in a Medicare Advantage plan to take advantage of additional coverage for prescription drugs and extra benefits like routine dental, hearing, and vision care. 

How does TFL work with prescription drug coverage? 

TRICARE insurance offers prescription drug benefits that exceed federal requirements. Because these benefits are considered creditable coverage, it isn’t necessary to enroll in a stand-alone Medicare Part D plan or to purchase a Medicare Advantage plan that includes prescription drug coverage. Your TFL prescription drug coverage should be sufficient. 

However, if your MA plan already includes prescription drug benefits, both plans will work together to pay their portion of your prescription drug costs. In this case, you should ensure that the pharmacy where you purchase your medications is listed on the networks of both your MA plan and your TRICARE plan.