TRICARE is a health care program for active duty service members, retirees, and their families. TRICARE for Life (TFL) is medical coverage for Medicare-eligible uniformed services retirees age 65 or older, their eligible family members and survivors, and certain former spouses. TRICARE Prime is a managed care option. TRICARE Standard is a fee-for-service plan in which you can see any TRICARE-certified/authorized provider. TRICARE Extra is mostly an option for people with TRICARE Standard who want to save on out-of-pocket expenses by making an appointment with a TRICARE network provider (doctor, nurse, practitioner, lab, etc.). All people with TRICARE are eligible for TRICARE pharmacy benefits.

People with TFL must have Medicare Part A and Part B to get TFL benefits. In general, for services covered by both Medicare and TFL, Medicare pays first for Medicare-covered services and TFL may pay second for services not covered by Medicare. For services covered only by Medicare, Medicare pays its share, and you pay any deductible, co-payment, or coinsurance. For services covered only by TFL, TFL pays first. You pay the TFL deductible ($150 for an individual, $300 for a family) and your share of the cost.

Source: CMS’ Medicare & You 2007 publication

Submitted By: Cindy Waters
Reimbursement Consultant
ABCM Corporation