Benefits of Tricare for Life

Published on Dec 3, 2014.

2 minute read

Tricare For Life (TFL) is a supplemental insurance program designed for the Tricare insurance program, which covers active-duty and retired members of the military, National Guard and reserve forces, their families, spouses and survivors. Tricare for Life is limited to retired or disabled Medicare beneficiaries carrying Part A and Part B coverage. Tricare for Life is a “secondary payer” that covers out-of-pocket expenses, co-insurance and deductible amounts set by the Medicare program.

How it Works

The physician or medical provider you use must be certified as a Medicare-eligible provider. The provider submits a completed claim form with the Medicare office, which reimburses the provider according to the Medicare fee schedule, less any co-pays and deductible amounts. Medicare then electronically submits the balance of the claim to TFL, which processes the remaining amounts and reimburses the provider directly. As beneficiary, you will receive a Medicare Summary Notice and a TFL Explanation of Benefits giving full details of the services, fees and amounts paid.

Services Covered

Tricare for Life pays claims generated by those services specifically covered by Medicare and/or Tricare. For those services not covered by Medicare, Tricare for Life becomes the primary insurance. In this case, the charge is processed with deductibles and co-pays set by the standard Tricare insurance program. For those services not covered by Tricare, you will pay the full Medicare co-pays and deductible. When neither form of insurance covers the service, you are responsible for the full cost.

Eligibility

There is no enrollment cost for eligible beneficiaries of Tricare for Life, but they must enroll in Medicare Part B and pay the scheduled premiums.

Other Health Insurance

If you have another form of health insurance, such as employer-covered insurance or private insurance, Medicare will not submit the claim directly to Tricare. Instead, you must file the Medicare Summary Notice and Tricare claim form DD Form 2642 to the office responsible for Medicare claim processing: WPS/TFL
P.O. Box 7890
Madison, WI 53707-7890

Shawn Hayes

Contributor

Shawn is a dedicated health and wellness writer, bringing a wealth of experience in nutritional coaching and holistic living. He is passionate about empowering readers to make informed choices about their physical and mental well-being. Outside of writing, Shawn enjoys hiking, mountain biking, and exploring new recipes to share with friends and family.

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