On October 1, 2001, Medicare-eligible uniformed services beneficiaries, their eligible family members and survivors gained access to expanded medical coverage known as TRICARE For Life (TFL) if enrolled in Medicare Part B. Under the law, health care for Medicare-eligible military beneficiaries became a permanent entitlement program, so it will not require annual renewals by the Congress. For services covered by both TRICARE and Medicare, TRICARE pays second to Medicare. You will incur no monthly premiums except for Medicare Part B.
TRICARE For Life is provided to the following: Medicare eligible retirees, including retired Guard members and Reservists; Medicare-eligible family members and survivors; and certain former spouses if TRICARE-eligible before age 65 who have not remarried and do not have employer-sponsored other health insurance. To take advantage of this benefit, eligible beneficiaries must be eligible for Medicare Part A and purchase Medicare Part B; properly registered in the Defense Enrollment Eligibility Reporting System (DEERS) and hold a valid military ID. Dependent parents and parents-in-law are not eligible for TFL benefits.
The DEERS (Defense Enrollment Eligibility Reporting System) Support Office can assist you in determining your eligibility for benefits under the TRICARE program. To obtain a current military ID card, an ID card issuing facility can provide information regarding the necessary documentation, address and hours of operation. The nearest facility can be located online at www.dmdc.osd.mil/rsl. If it isn't possible for you to physically go to an ID card facility, you should call the Defense Manpower Data Center Support Office at 1-800-538-9552 (Monday thru Friday 6 AM to 3:30 PM, PT)
You will need to provide the following documentation to your local military personnel office, or have someone provide the documentation on your behalf:
A letter from the physician stating you are not physically/mentally capable of traveling the distance to the nearest military treatment facility (MTF) or ID card issuing facility;
A 5 x 7 photograph;
An old military ID card; and
Your name, address, city, state, zip code and telephone number (including area code).
NOTE: If the beneficiary is unable to communicate, a P.O.C. (Point of Contact) should be given. For additional assistance, beneficiaries who cannot physically go to an ID card issuing facility may call the DoD Reverification line at (800) 361-2620,
In instances where the services performed are not Medicare-covered services, but are TRICARE-covered services, TRICARE will pay the provider its authorized amount (75/80 percent depending on whether a network or non-network provider/facility is used) and the patient will be responsible for a cost share and annual deductible.
Assignment is an agreement between Medicare and providers. When providers agree to accept assignment they accept the Medicare allowable charge as the full fee for your care (including cost share). Providers can accept assignment on a case-by-case basis.
Medicare does not cover services provided outside of the continental United States, however TFL will pay for TRICARE-covered services. TRICARE will pay 75 percent of the allowable charges and you will be responsible for the remaining 25 percent after the TRICARE annual deductible has been met.
That is a decision that is up to the beneficiary only. If the beneficiary has a Medicare supplemental policy when the TRICARE For Life claim is processed, Medicare will pay the provider as it usually does and forward the claim to the supplemental plan as well as to TFL. Both will process the claim, but only the supplemental plan will pay the provider. Both will send Explanation of Benefits statements you. You can compare what TFL would have paid with what the commercial supplement paid and judge the quality of the TFL coverage. Then you can make a decision.
The main TRICARE for Life customer service number is 1-866-773-0404. TTY/TDD callers can contact TRICARE for Life at 1-866-773-0405. Beneficiaries can also visit TRICARE for Life. Wisconsin Physicians Service (WPS) is the claims processor for all claims for beneficiaries who are eligible for both TRICARE and Medicare. Claims are submitted on your behalf by your provider. The basic claims address is: WPS TRICARE for Life, PO Box 7890, Madison, WI 53707-7890.
Medicare certified providers do not need to submit claim forms to TRICARE for TRICARE For Life claims. Medicare certified providers file their claims directly to Medicare. Medicare will process (and pay, if applicable) each claim according to its determination that the care the beneficiary received is a Medicare benefit. Medicare will automatically send that claim to TRICARE (with the exception of those patients who are covered by Medicare but under the age of 65). TRICARE will process (and pay, if applicable) the claim according to Medicare’s determinations.
The automatic claim crossover process does not apply to Medicare replacement policies, such as a Medicare HMO. A Medicare certified provider must file a claim directly to the Medicare replacement carrier. Upon receipt of the Medicare replacement carrier’s Explanation of Benefits (EOB), the provider must then file a paper claim to TRICARE, with a copy of the Medicare replacement carrier’s EOB, for processing.
TRICARE must have EOBs from Medicare and any other health insurance before it can process (and pay if applicable) a claim as the third payer.
