Affordable health care is a top concern for retirees, especially those who “age out” of most Tricare plans at 65.
For Medicare-eligible Tricare beneficiaries and their families, Tricare for Life is a convenient continuing health care option that balances affordability and access to care.
Table of Contents
- What is Tricare for Life?
- Tricare for Life Top Five Facts You Need to Know
- Eligibility and Costs
- Enrollment Basics
- Important Tricare for Life Resources
- Advantages & Disadvantages
- Summary: Tricare for Life is a Valuable Program
What is Tricare for Life?
Congress introduced Tricare for Life in 2001 to expand health benefits for the retired population.
Prior to 2001, Tricare stopped covering military retirees and their eligible family members at age 65, leaving them to rely solely on Medicare. Medicare is a US government program that provides health care to Americans over 65 and those with certain qualifying disabilities.
Tricare for Life is a “Medicare-wraparound” coverage in which Tricare acts as a second payer that covers costs after Medicare. Tricare for Life is available worldwide — even outside of the United States, where Medicare is unavailable. For retirees living in foreign countries, Tricare for Life acts as the first payer for health care.
Tricare for Life Top Five Facts You Need to Know
- Freedom of Choice: Beneficiaries can choose from any Medicare-authorized provider, but selecting providers who opt out of Medicare – including Department of Veterans Affairs (VA) providers – could lead to greater out-of-pocket expenses.
- Medicare Part A: To be eligible for Tricare for Life, you must enroll in Medicare Part A. If you or your spouse has worked more than 10 years in your lifetime, then you are eligible for Medicare Part A with no premiums.
- Medicare Part B: Tricare for Life also requires you to enroll in Medicare Part B. Medicare Part B premiums for 2023 start at $164.90.
- Greater Out-of-Pocket Costs Overseas: Medicare does not extend outside the US, so Tricare for Life is the primary payer for health care received in all foreign locations. You must pay deductibles and cost-shares for care outside of the United States.
Long-term Care: The plan covers skilled nursing facilities but not nursing homes or assisted living facilities. To obtain long-term care coverage, investigate the Federal Long Term Care Insurance Program or commercial coverage options.
Eligibility and Costs
Am I Eligible?
When retirees and their family members become eligible for Medicare at age 65, they are no longer eligible for Tricare Prime or Tricare Select.
All Tricare-eligible beneficiaries with Medicare Parts A and B are eligible for Tricare for Life. Tricare for Life has no enrollment fees, but you must first enroll in Medicare and pay Medicare Part B premiums.
People under age 65 who qualify for Medicare because of end-stage renal disease, Lou Gehrig’s disease, mesothelioma or a qualifying disability may be able to retain Tricare Prime at no cost, according to Tricare’s Medicare page. Check with your regional Tricare contractor for more information and options.
Note: Tricare for Life is an individual entitlement, so if you qualify for Tricare for Life, but your spouse isn’t old enough yet, they keep their original Tricare Prime or Tricare Select benefit until they qualify, according to a 2021 Tricare press release.
You don’t have to pay for Medicare Part A coverage as long as you or your spouse worked and paid payroll taxes for at least 10 years, according to the Medicare website. If you haven’t met these requirements, the 2023 rate Part A rate for most people is $506 per month in 2023.
In 2023, single filers making less than $91,000 annually pay a monthly Part B premium of $164.90. The rates increase from there based on your income and filing status.
As a wraparound coverage, Tricare for Life normally pays the remaining medical bills after Medicare has paid its share. But if you are an inpatient in a hospital for longer than 150 days or are receiving care outside of the United States, you’ll have to pay Tricare for Life deductibles and cost-shares, according to the Tricare for Life page. You’ll also incur these costs if you choose non-network providers or those who opt out of Medicare.
Note: VA providers can’t bill Medicare, so if you get non-service related care from a VA provider, you’ll incur significant out-of-pocket costs, according to the Tricare for Life website.
The amount you would pay for deductibles and cost-shares when Medicare coverage isn’t available depends on multiple factors, which are explained in this 2022 Tricare for Life cost matrix. According to two Congressional Research ServiceTricare for Life cost-shares will not change in 2023.
If your information in DEERS is up to date, then coverage is automatic for Tricare beneficiaries with Medicare Parts A and B.
Medicare-eligible people should sign up for Medicare several months before their 65th birthday. Signing up promptly for Medicare will enable Tricare-eligible beneficiaries to avoid any break in Tricare coverage.
You can find out more about when to sign up for Medicare and other questions about how it works with Tricare in this “Tricare and Signing up for Medicare” brochure.
Important Tricare for Life Resources
- WPS: 1-866-773-0404
- International SOS: Phone numbers for regional call centers are available here.
Additionally, you can download the comprehensive Tricare for Life handbook and other resources from the Tricare publications page.
Advantages & Disadvantages
Tricare for Life can seem relatively complex when compared with other Tricare plans due to its Medicare-wraparound nature, but it yields substantial advantages for eligible populations.
Tricare for Life: Advantages
- Global Coverage: This plan is available worldwide and does not have specific service areas. For those living overseas, Tricare for Life benefits are still available, but out-of-pocket costs will be higher since Medicare isn’t contributing to the cost.
- Affordability: There is no annual deductible for services covered by both Medicare and Tricare, so the beneficiary does not have to pay for routine services.
- Claims: Providers generally file claims directly with Medicare, which will pay its portion and forward the remaining claim to Tricare, so you won’t have any additional paperwork.
- Freedom: Beneficiaries can choose any Medicare-eligible provider. However, it’s important to note that care delivered from VA providers or those who opt out of Medicare will be more expensive since Medicare will not contribute to the overall cost.
Tricare for Life: Disadvantages
- Multiple Agencies: You’ll have to deal with both Tricare and Medicare, although usually, this process is seamless.
- Nursing Home Coverage: Tricare for Life doesn’t cover certain services, like long-term care in a nursing home or assisted living facility. You may consider getting additional coverage for this possibility through Federal Long Term Care Insurance Program or a commercial provider.
Summary: Tricare for Life is a Valuable Program
Tricare for Life provides excellent gap coverage for costs that Medicare doesn’t pay. With no enrollment fees, you can get this wraparound coverage for free as long as you enroll in and pay Medicare Part B premiums. When outside of the United States, Tricare for Life serves as the primary payer, so you’ll assume cost-shares and pay deductibles.