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Other Health Insurance

How TRICARE For Life Works with Medicare

Medicare and TRICARE For Life (TFL) work together to minimize your out-of-pocket expenses. However, there are instances when some health care costs may not be covered by Medicare and/or TFL. See the chart below which breaks down what you should pay based on how the service is covered.   

 

How the service is covered What you pay
By both Medicare and TRICARE For Life    
 

*Medicare pays first

*TRICARE For Life pays second

*You pay nothing

By TRICARE For Life but not Medicare    
 

*TRICARE For Life pays first

*Medicare pays nothing

*You pay the TRICARE For Life  fiscal year deductible and cost shares

By Medicare but not TRICARE For Life    
 

* Medicare pays first

*TRICARE For Life pays nothing

*You pay the Medicare deductible and coinsurance

Not covered by Medicare or TRICARE For Life    
 

* Medicare pays nothing

*TRICARE For Life pays nothing

*You pay the entire bill


To determine if Medicare covers a specific service or benefit, visit www.medicare.gov or call 1-800-633-4227. To determine if TFL covers the service or benefit, visit the Defense Health Agency (DHA) site. 

Coordinating TRICARE For Life with Other Health Insurance besides Medicare

How Medicare coordinates with other health insurance (OHI) depends on whether or not the OHI is based on current employment. In either case, TFL is the last payer. If you have OHI that is not based on your or a family member’s current employment, Medicare pays first, the OHI pays second, and TFL pays last.

OHI Based on Current Employment

Generally, if you have an employer-sponsored health plan based on current employment, that health plan pays first, Medicare pays second, and TFL pays last. If there are fewer than 20 employees in the employer-sponsored plan, Medicare pays first, the employer plan pays second, and TFL pays last. Please note: TFL pays after most insurance plans with the exception of Medicaid, TRICARE supplements, the Indian Health Service, and other programs and plans as identified by the Defense Health Agency. For more information on how TFL works with OHI please visit the Defense Health Agency (DHA) site. 

Frequently Asked Questions related to how TRICARE For Life works with Other Health Insurance

Do you pay for the Medicare Part B premium?

The Part B monthly premium is your responsibility. TFL covers the Medicare Part B deductible as long as the health care service is covered by both Medicare and TFL.

How do you work with OHI besides Medicare?

How Medicare coordinates with Other Health Insurance (OHI) depends on whether or not the OHI is based on current employment. In either case, TFL is the last payer. If you have OHI that is not based on your or a family member’s current employment, Medicare pays first, the OHI pays second, and TFL pays last.

How do you work with my current insurance through my employer?

Generally, if you have an employer-sponsored health plan based on current employment, that health plan pays first, Medicare pays second, and TFL pays last. If there are fewer than 20 employees in the employer-sponsored plan, Medicare pays first, the employer plan pays second, and TFL pays last. 

Should I cancel my Supplement, Advantage Plan, or OHI?

You should carefully evaluate your health insurance needs to determine if you should continue Medicare supplements, Medicare Advantage Plans, or OHI. You may contact your local State Health Insurance Assistance Program for free health insurance counseling and assistance. For more information, visit www.shiptalk.org.

Do I need to contact TFL if I drop my OHI coverage? 

A: Yes, it is very important to notify TFL immediately. We need this information to properly process your claims. If you already have an online account you can make this update yourself in the Family Profile area. You can also complete this Other Health Insurance Questionnaire and mail or fax the form to the information at the bottom of the form. You can also call us at 1-866-773-0404 and we will assist you with properly updating your OHI records.   

How do I file a claim that includes OHI payment information?

When your OHI processes the claim after Medicare, you or your provider of services can submit a claim to TRICARE For Life for any remaining balance. The claim must include a claim form and the supporting Medicare and Other Health Insurance Explanation of Benefits (EOB) that corresponds to the charges filed.  Claims can be filed on line through this web site. To submit online you must have an active account. Once you create an account you can submit a new claim in the message center. If you would like to file the claim by postal mail, send all claims to:

WPS/TRICARE For Life
P.O. Box 7890
Madison, WI 53707-7890

I need more information!

TFL pays after most insurance plans with the exception of Medicaid, TRICARE supplements, the Indian Health Service, and other programs and plans as identified by the Defense Health Agency. For more information on how TFL works with OHI please visit the Defense Health Agency (DHA) site. You can also view our Other Health Insurance FAQ word document.