How Does Medicare Work with TRICARE?

TRICARE is a health insurance program offered to active and retired military personnel, their spouses, and dependents. It offers comprehensive medical benefits and is accepted all over the world. If you are 65, you’re also eligible for Medicare. The question we get asked most often by retired military members is, “How does TRICARE work with Medicare?”

Original Medicare and TRICARE

Almost all individuals should enroll in Medicare Part A as soon as they turn 65. It’s premium-free for most beneficiaries, which is why many people choose to enroll even if they still have other health insurance. Military personnel can choose to delay Medicare Part B in three instances:

• If they are still on active duty.
• If they are inactive but have other creditable coverage through another group health plan.
• If they’re enrolled in TRICARE Young Adult, TRICARE Reserve Select, or the US Family Health plan.

In these three cases, individuals can choose to delay their Part B enrollment and continue their TRICARE coverage. There will be no late-enrollment penalties in these instances, and TRICARE will continue to act as the member’s primary insurance plan.

As soon as a TRICARE-eligible person enrolls in both Part A and Part B, their TRICARE coverage changes to TRICARE for Life (TFL). There is no paperwork involved in the process; the change will occur automatically. Enrollees will be responsible for the Part B premium.

After you’re enrolled in both parts of Medicare, Medicare becomes your primary insurance plan, and TFL acts as your secondary plan. After your medical claims are paid by Medicare, they’ll be sent directly to TFL for payment. In most cases, beneficiaries are left with no out-of-pocket costs.

There is no need to enroll in Medicare Part D as prescriptions are covered by TFL. TRICARE is considered creditable coverage, which means it offers coverage that is just as good (or better) than Medicare plans. Beneficiaries who decide they would like to enroll in Part D can do so at any time.

Medicare Advantage and TRICARE for Life

While Medicare and TFL do offer comprehensive medical coverage, they’re missing a few things. Neither plan includes coverage for:

• Routine and restorative dental treatment
• Vision exams and prescription glasses or contacts
• Hearing exams and hearing aids
• Long-term care
• Acupuncture
• Chiropractic services

Because of these gaps in coverage, many TFL members choose to enroll in a Medicare Advantage plan.

Medicare Advantage (Part C) plans are an alternative to Original Medicare. You’ll still be required to pay the Part B premium, but you can choose to enroll in a Medicare Advantage plan, which often has low (or $0) premiums. Some MA plans are tailored to veterans and may even have Part B givebacks, which will reduce your Part B premium.

If you choose to do this, your Medicare Advantage plan will still be your primary insurance plan, and TFL your secondary plan. However, you may need to be more careful about where you receive care. Medicare Advantage plans operate on provider networks, so you should try to get your care from a contracted doctor or facility.

Medicare Advantage plans do not coordinate automatically with TFL. That means that after your Medicare Advantage plan pays on a claim, you may need to file the secondary claim with TFL yourself. You’ll still have the same coverage under TFL, but it may require you to do some work, and you may have to pay out-of-pocket for services before being reimbursed by TRICARE.

If you’re a veteran and curious about how your benefits will change when you enroll in Medicare, talk with one of our insurance agents. We can help you navigate the process and help you decide which plans may be a good fit for you. And lastly, thank you for your service!