Tricare for Life: Understanding its Eligibility, Costs and Benefits

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What is Tricare for Life?

Out-of-Pocket Expenses to Expect with Tricare for Life

Will the 2018 Changes Effect Tricare for Life?

How Tricare for Life and Medicare Work Together

Tricare for Life Coverage Limitations

Am I Eligible for Tricare for Life?

What If I Am Not Eligible for Tricare for Life?

Questions about Tricare for Life? Get in Touch Here

Tricare For Life is one of many healthcare benefit programs offered by the United States Department of Defense Military Health System.

Tricare provides civilian health benefits for active and retired military personnel and their dependents. Some members of the Reserve Component are qualified to receive Tricare benefits as well.

Historically, Tricare was known as CHAMPUS: the Civilian Health and Medial Program of the Uniformed Services.

In the years following World War II and the Korean War , more and more veterans needed healthcare for themselves and their families.

If you take into account the increased demand of veterans needing healthcare combined with the expansion of active military due to the the Cold War, it is no wonder the traditional, military provided healthcare system could no longer meet the needs of its members.

CHAMPUS was the answer to that problem.

Congress passed the Military Benefits Amendments of 1966 which worked along side the Dependents Medical Care Act of 1956. This legislation allowed the Secretary of Defense to contract with civilian health care providers to meet the increased demand.

In 1993, as a result of the requirements laid out in the Department of Defense (DoD) Appropriation Act for Fiscal Year 1994, the DoD announced plans for a nationwide managed care program for military personnel and their dependents, active and retired. This program became known as Tricare

After October of 2013, Tricare was no longer managed by the Tricare Management Activity under the direction the Assistant Secretary of Defense.

Currently, Tricare is managed by the new Defense Health Agency. In the past, the United States was divided into twelve regions that managed Tricare coverage. Sine then, it has been dramatically simplified into Tricare East and Tricare West.

What is Tricare for Life?

Congress enacted Tricare for Life as a response to complaints by beneficiaries who were having trouble paying their out-of-pocket Medicare costs.

Many on Capital Hill saw the need for a military healthcare benefit plan that would cover these out-of-pocket expenses instead of military retirees being required to purchase Medicare Supplemental Coverage.

Tricare for Life, also known as TFL, provides comprehensive health care coverage for retired military. TFL allows you the freedom to seek medical care from both Medicare-participating providers and/or non-participating providers.

Unless you have other health care coverage, once Medicare has paid its portion, the claim is automatically sent to Tricare for processing. Tricare for Life pays after Medicare and other coverage has paid its portion.

Out-of-Pocket Expenses to Expect with Tricare for Life

There are no enrollment fees with Tricare for Life, but you must pay a monthly premium for Medicare Part B. That premium will be based on your income.

Services covered by both Medicare and Tricare will have no out of pocket costs. That being said, there are costs associated with Tricare for Life:

You are responsible for Medicare deductibles, and any cost shares for procedures that are covered by Medicare, but are not covered by Tricare.
You are responsible for ay deductible and cost shares associated with medical procedures that are covered by Tricare, but are not covered by Medicare.
You are responsible for any medical procedures that are not covered by either Tricare or Medicare. For example, Tricare for Life does not cover cosmetic surgery or dental work. In this instance, you are responsible for the entire amount.

Will the 2018 Changes Effect Tricare for Life?

Nearly all Tricare coverage plans will face sweeping changes this year (2018). However, Tricare for Life coverage will remain almost completely unchanged.

The reason that Tricare for Life will not be effected by the sweeping changes of Tricare coverage is that Tricare for Life works with Medicare Part B as wrap-around, health insurance coverage.

As we discussed, Tricare for Life includes an annual deductible that users must pay out-of-pocket when receiving care.

The major change is that, instead of that deductible resetting every October 1st, the deductible will reset every January 1st. This will bring the Tricare deductible calendar in line with most healthcare providers in the country.

How Tricare for Life and Medicare Work Together

You must have both Medicare Part A and Medicare Part B to be eligible for Tricare for Life coverage.

Medicare Part A is premium free health insurance policy for most people. Part B does charge a monthly premium. Both plans have additional costs for deductibles, copays and any coinsurance. It is because of the increasing costs of deductibles and copays for Medicare recipients that Tricare for Life is an excellent health insurance option for retired military personnel.

Tricare for Life is Medicare wraparound coverage. It has a prescription drug benefit, so you may not need a Medicare Part D plan. Don’t worry. If you have Tricare for Life, and eventually decide you want to enroll in a Part D plan, you can — at any time.

Tricare for Life Coverage Limitations

Like any healthcare insurance plan, Tricare coverage has its limitations. For example, Tricare does not cover chiropractic care (because it cannot be administered in a doctor’s office or a hospital). Tricare does not cover abortions, emergency contraceptives, or any cosmetic surgery. It does not cover non-surgical treatment for weight loss, or over-the-counter products that help you quit smoking.

Probably the biggest downside is that Tricare does not cover dental work.

Am I Eligible for Tricare for Life?

Who is eligible for Tricare for Life?

Regardless of your age, you are available for Tricare for Life if you are entitled to Medicare Part A and have Medicare Part B. The following list is a general breakdown of the Tricare for Life eligibility requirements:

You are an active duty or retired uniformed service member.
You are the spouse or child of an active duty or retired uniformed service member.
You are a National Guard or Reserve member.
You are the spouse or child of a National Guard or Reserve member.
You are the former spouse of a military member.
You are a Medal of Honor recipient.
You are the spouse or child of a Medal of Honor recipient.
You are registered in the Defense Enrollment Eligibility Reporting System (DEERS).

There are always exceptions to eligibility. So, check with your regional contractor for additional exemptions.

What If I Am Not Eligible for Tricare for Life?

Other than Tricare for Life, there are several health care benefit programs available under the Tricare system.

Tricare Standard: Tricare Standard is available to retirees from the Active Component, and retirees from the Reserve Component who are age 60 or older. It is available to their family members, too. Tricare Standard beneficiaries are free to use a civilian health care provider of their choosing (as long as that provider is payable pursuant to Tricare regulations). There is no enrollment fee associated with Tricare Standard, but the beneficiary is responsible for a deductible and other out-of-pocket expenses that are not covered.
Tricare Extra: If you are a Tricare Standard beneficiary, you can choose a Tricare Extra option. In that case, you would use a civilian health care provider within the regional network, and Tricare Extra PPO (preferred provider program). Under Tricare Extra, the beneficiary's coinsurance amount is reduced by at least five percent. Other than the cost of coinsurance, there is no fee for the use of the Tricare Extra.
Tricare Prime: Are you are familiar with how an HMO health insurance plan works? Tricare Prime is very similar to an HMO. Active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their family members are eligible for Tricare Prime. Beneficiaries are assigned a primary care manager (PMC) and obtain referrals for specialized care.
Tricare Reserve Select (TRS): This is a premium-based health insurance plan for qualified active National Guard and Reserve members. TRS beneficiaries are required to pay a monthly premium. It offers coverage similar to Tricare Standard and Tricare Extra. Like civilian private or public sector employer plans, Tricare Reserve Select has a partial premium cost sharing arrangement with the Department of Defense. The program coverage is available worldwide to Selected Reserve (SELRES) members
Tricare Reserve Retired: This premium-based health plan for retired National Guard and Reserve members under the age of 60. It works much like Tricare Reserve Select. However, there is no premium cost sharing arrangement with the Department of Defense. Retired Reserve Component members who purchase this plan are required to pay 100% of the premium.
Tricare Young Adult: This is another premium-based health care plan. TYA is available for purchase by qualified dependents who have aged out (21 years old) of Tricare. If you are a full time student, you must be 23 or older. Dependents are eligible if they are unmarried, and they are not eligible for other Tricare coverage or their own employer-sponsored health care coverage. Also, their sponsor must be Tricare eligible.

Questions about Tricare for Life? Get in Touch Here

If you have any questions about Tricare for Life, or other health care benefits available under Tricare, contact one of the regional offices or regional contractors. In most cases, you will contact your regional contractor. However, if you are looking for Prime Travel Benefits approval, eligibility requests for Tricare Prime Remote, or need to resolve an issue with your regional contractor, you should contact your Tricare Regional Office.