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TRICARE For Life

Managed by the Defense Health Agency (DHA), TRICARE is the health care program that provides comprehensive health care coverage to its beneficiaries. Although often referred to a manner suggesting a single model of care, TRICARE is actually the programmatic name that represents over eight core health care delivery plan options, including TRICARE For Life (TFL).


TFL is specifically for Uniformed Service retirees (usually referred to more simply as “military retirees”) and their spouses. It is not available to other family members, such as a military retiree’s children. Military retirees eligible for TFL have completed a minimum of 20 years of service, are entitled to Medicare Part A, and enrolled in Medicare Part B.


TFL is not insurance and the enrollees are not required to pay a premium. While not a direct comparison, TFL is most similar to commercial Medicare supplement plans or Medicare wraparound coverage. TFL is intended to cover what Medicare does not cover for health care services related to preventative care, primary care, specialist care, hospitalization, and prescription drugs in order to reduce a military retiree’s out-of-pocket expenses for health care services. TFL can be applied toward deductibles, copayments, and coinsurances. TFL also provides coverage for dental, vision, and hearing care to include hearing aids, which are not typically covered by Medicare Part A or Part B. TFL also provides worldwide healthcare coverage, which is a strong differentiator from Medicare and most private insurance policies.  


When an individual receives care, Medicare processes the provider’s claim first. Medicare then automatically forwards the claim to TFL for additional processing and payment. The seamlessness between Medicare and TFL means the enrollee is not burden with independently filing a claim to receive TFL benefits.


If an individual also has a Medigap policy or other health insurance policy, including health insurance provided through the retiree’s direct employer or a spouse’s employer, the coordination of benefits gets a little more complicated. Whether Medicare or the commercial health insurance plan pays first depends on an individual’s age, employment status, and number of people under the employer’s health insurance plan. This combination of factors determining which entity pays first is worked out between Medicare and the commercial health insurance plan; however, the universal truth is that TFL always pays last.


TFL can play a crucial role in providing healthcare coverage for military retirees. It is essential for pharmaceutical and medical device manufacturers to understand its unique structure and interplay with Medicare and other insurance policies to best assess a military retiree’s full benefits coverage for its products.

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