TRICARE for Life and Medicare: The Best Supplement You Can’t Buy

How the wraparound works

With TFL, Medicare is your primary payer and TRICARE pays second (or last, if you also have employer insurance). For care that Medicare and TRICARE both cover, the two coordinate automatically: your provider files with Medicare, Medicare pays its share and forwards the claim to the TFL contractor, and TFL picks up your coinsurance and deductible. No claim forms from you, and for that category of care, typically nothing out of pocket. Services only one program covers follow that program’s rules, with the other’s cost-sharing applying.

The Part B requirement, in every direction

• No Part B, no TFL. The wraparound exists only while both Part A and Part B are in effect, and you pay the standard Part B premium (income-based; see IRMAA if your income is high).
• At 65, TFL is the path. TRICARE’s rule for retirees: once you’re 65 and Medicare-eligible, you become eligible for TFL and can no longer enroll in the other TRICARE plans. Signing up for Part B on time is what keeps coverage seamless.
• Overseas, Part B is still required. Even though Medicare doesn’t cover care outside the U.S., you must keep Part B to remain TRICARE-eligible abroad, where TRICARE acts as the payer.
• If you missed the window, Medicare.gov lists a Special Enrollment Period for people with TRICARE: it starts when Social Security notifies you and runs 12 months. Don’t count on being notified promptly; if you’re a retiree approaching 65, treat Part B sign-up as your own project.

Drug coverage: you probably don’t need Part D

TFL includes prescription coverage through the TRICARE Pharmacy Program, and TRICARE states directly that “you don’t need Medicare Part D to have prescription coverage.” TRICARE’s pharmacy benefit counts as creditable coverage, so skipping Part D doesn’t build up the late-enrollment penalty as long as you keep it. TRICARE’s own list of reasons someone might still add Part D: a Part D formulary that covers a drug TRICARE doesn’t, and Extra Help for people with limited income, which can make a Part D plan effectively free.

TFL with Medicare Advantage: possible, with homework

You can pair TFL with a Medicare Advantage plan instead of Original Medicare. TRICARE will reimburse copayments you pay for TFL-covered services, though you may need to file those claims yourself, which trades the automatic claim flow for whatever the Advantage plan offers. Since most Advantage plans bundle drug coverage you already have through TRICARE, and since TFL already caps your costs on Original Medicare, the case for switching is narrower for TFL holders than for most people. The general trade-offs are in Medicare Advantage vs. Medigap; one thing TFL settles for you is that buying Medigap is unnecessary, because TFL already does that job.