TRICARE for life, what you need to know

  • Published
  • By Shari Lopatin
  • TriWest Healthcare Alliance
TRIWEST --  If you're approaching 65, you may have to make some decisions about your family's health care coverage.

When it comes to health care, you shouldn't have to worry. TRICARE for Life is TRICARE's wrap-around coverage for those who are also eligible for Medicare. Take the time to learn how you can take advantage of your health care entitlement.

What is TFL?
TFL acts as a secondary insurance to Medicare, minimizing your out-of-pocket costs. In other words, claims will go to Medicare first and then to TFL. If the service is covered by both Medicare and TRICARE, Medicare coverage will pay first and TFL will then pay any Medicare deductibles, Medicare cost-shares and Medicare copayments. You can view eligibility and cost information at www.tricare.mil/tfl. 

What makes me eligible?
TFL is available to TRICARE beneficiaries 65 and older with a valid military ID card who are enrolled in both Medicare Parts A and B. Don't forget to confirm that your Medicare status is current in the Defense Enrollment Eligibility Reporting System. TFL is based on the family member that reaches 65 and, therefore, another family member may still be using one of the other TRICARE programs if not yet eligible for TFL.
What are my Medicare enrollment deadlines? 

Generally, you become eligible for Medicare at age 65. About 90 days prior to turning 65 you will receive mail from Social Security and Medicare advising you about your Medicare options. If you decline Medicare Part B, your TRICARE benefits will end the day you would have become eligible for Medicare. If you accept Medicare Part B, your TRICARE benefits will continue in the form of TFL. In most cases, if you don't enroll in Part B during your initial eligibility period, you must wait until the next general enrollment period between January 1 and March 31 of the following year. If you enroll at that time, the Part B premiums may increase an additional 10 percent for each 12-month period you were eligible to enroll in Medicare, but did not.

What about claims?
Medicare is the primary claims processor for TFL beneficiaries, and TRICARE is secondary for both dual-eligible beneficiaries and TFL. This means claims will be sent to Medicare first, and TRICARE second. Additionally, Medicare supplemental programs are considered primary over TFL. Typically, if the only medical coverage involved is Medicare Part A and B, and TFL - your provider will submit the claim to Medicare and Medicare will automatically send the claim to WPS, which manages the TFL program. You can reach WPS for questions about claims and customer assistance at 1-866-773-0404 or www.tricare4u.com.

Where can I find more information?
Check out these handy online resources for more information on TFL and Medicare:
· www.medicare.gov for more information on Medicare premiums, enrollment deadlines and eligibility.
· www.tricare.mil/tfl for initial details about TRICARE for Life, including the entitlement's key features.
· www.triwest.com/beneficiary/default.aspx. Go to "update DEERS" to confirm that your Medicare status is current in the DEERS system, which you will need to do to determine eligibility for TFL.

Wisconsin Physicians Service is the TRICARE for Life benefit administrator and you can reach them at 1-866-773-0404 and through their Web site at www.tricare4u.com.