Chapter 3: TRICARE for Life and Medicare
How military retirees keep world-class coverage, and why Parts A & B are absolutely mandatory
1. Do You Qualify for TRICARE for Life?
Let’s start by making sure we’re talking about you. TRICARE for Life (TFL) is arguably one of the best healthcare benefits available to any group of Americans, but not every veteran qualifies. Understanding the requirements is crucial because the rules are non-negotiable.
You’re eligible for TFL if:
- You served 20+ years of active duty (or equivalent Guard/Reserve time)
- You’re enrolled in both Medicare Parts A and B
- You’re a qualified spouse or dependent of an eligible military retiree
The part that trips up many military retirees is this: You must have Medicare Parts A and B. Not just Part A. Not “eventually” Part B. Both parts, active and current. Period.
Some medical retirees with disability ratings also qualify, but the Medicare requirement remains exactly the same for everyone. No exceptions, no special circumstances, no waivers.
Many attempt to skip Part B to save on the monthly premium, but this can be a costly mistake. What they often don’t realize is that doing so also leaves them exposed to lifelong penalties on their Part B premium if they enroll later.
Furthermore, there are many Medicare options with premiums as low as $0 that can help you avoid overpaying for Part B. These options also work with TFL, with TFL providing wraparound coverage for any deductibles, copays, and coinsurance the option doesn’t cover. Choosing to skip Part B means missing out on these valuable benefits you’ve earned.
2. Why Medicare Parts A & B Are Absolutely Non-Negotiable
This isn’t a suggestion from some bureaucrat; it’s federal law written into the statute that created TRICARE for Life. Let me explain why this requirement exists and why you absolutely cannot get around it.
It’s Written in Federal Law
TRICARE for Life was established by Public Law 106-398 (Fiscal Year 2001 National Defense Authorization Act) and is currently governed by 32 CFR § 199.17, which specifically requires both Medicare Parts A and B. The regulation is crystal clear: “when a retiree or retiree family member becomes individually eligible for Medicare Part A and enrolls in Medicare Part B, he/she is automatically eligible for TRICARE-for-Life.” (Source: Law.Cornell.edu, https://www.law.cornell.edu/cfr/text/32/199.17)
The law specifically states that TFL can only function as secondary coverage after Medicare pays first. This means that whether you have Original Medicare or a Medicare Advantage (Part C) plan, your Medicare coverage acts as the primary payer before TFL.
Think of it this way. Medicare is the engine, and TFL is the transmission. You need both for the system to work.
The Financial Architecture
TFL was designed as a “wraparound” benefit that eliminates most out-of-pocket costs after your primary Medicare coverage pays its portion. This means that whether you have Original Medicare or a Medicare Advantage (Part C) plan, the entire financial structure depends on your Medicare coverage being the primary payer:
- Your Medicare coverage pays the majority of your medical bills first
- TRICARE for Life covers what Medicare doesn’t pay
- You end up with virtually zero out-of-pocket costs
Without this Medicare foundation, TFL has nothing to “wrap around” and simply cannot function.
Preventing System Gaming
The Medicare requirement also prevents people from only enrolling when they get sick. If military retirees could choose whether to have Medicare, many healthy retirees might skip it and only enroll when they developed serious health problems. This would drive up costs for everyone and destabilize both systems.
3. How Your Medicare Coverage and TFL Work as a Perfect Team
When you have both your Medicare coverage (whether Original Medicare or a Medicare Advantage plan) and TRICARE for Life active, this is exactly what happens when you receive medical care.
Step 1: Your Medicare Coverage Pays First
Your healthcare provider submits the claim to your Medicare coverage first. Your Medicare plan processes it according to its rules and pays its portion based on Medicare’s approved amount.
Step 2: TRICARE for Life Processes the Remaining Balance
The way TRICARE for Life receives the claim depends on your Medicare choice.
If You Have Original Medicare: Medicare electronically forwards the claim information to Wisconsin Physician Services (WPS), which administers TRICARE for Life. You typically don’t need to file a separate claim or do anything, as this integration happens automatically to cover your deductibles, copays, and coinsurance.
If You Have a Medicare Advantage (Part C) Plan: Your provider will send the claim to your Part C plan, which pays the majority of the cost. Then, it’s common for your provider to send the remaining deductible, copay, or coinsurance portion directly to Wisconsin Physician Services (WPS), which administers TRICARE for Life. WPS then pays the medical provider the amount owed.
We’ve learned that most providers already know how to bill properly, often because they accept TRICARE Prime or Select. If a provider does not bill TFL directly, DD Form 2642 is available for you to submit to get reimbursed for any deductible, copay, or coinsurance payments you make to your provider (Source: Department of Defense, https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2642.pdf). While we used to provide this form to clients frequently in the past, we have not been asked for it in several years. This is because medical provider offices are becoming increasingly accustomed to billing different entities as more of their patients age into Medicare.
Step 3: You End Up with Near-Zero Out-of-Pocket Costs
TRICARE for Life reviews what your Medicare coverage paid and automatically covers most of what Medicare didn’t pay, including deductibles, coinsurance, and copays.
4. Real Example: How It Works
If you have Original Medicare
Let’s say you need outpatient surgery that costs $8,000:
- Medicare Part B deductible: You pay $257 (2025 amount)
- Medicare pays 80%: $6,194 of the remaining balance
- Medicare coinsurance (20%): $1,549 you would normally owe
- TFL pays the deductible and coinsurance: $1,806
- Your total out-of-pocket cost: $0
If you choose Medicare Part C with the same $8,000 outpatient surgery
Most Part C plans have flat copays for outpatient surgery, and many also have a $0 deductible. For this example, we will say the copay is $1,000; if there is a deductible, TFL will pay that as well.
- TFL pays $1,000 copay
- Your total out-of-pocket cost: $0
This integration creates virtually bulletproof coverage. I’ve seen military retirees go through major medical events (cancer treatments, heart surgeries, extended hospital stays) and walk away with minimal or zero bills.
5. The Generic Advisor Mistake: Selling Unnecessary Medigap
Here’s where I see the most expensive mistake that military retirees make, often because they get advice from generic Medicare advisors who don’t understand TRICARE for Life.
A typical Medicare advisor sees a military retiree approaching 65 and thinks, “This person needs Medicare Supplement insurance to cover the gaps.” So they recommend a Medigap Plan G for $125-$300 per month.
The problem: TRICARE for Life already functions as the best Medicare Supplement insurance available. In fact, it works better than Medicare Supplement from private insurance companies because it will pay deductibles, copays and coinsurance for Medicare Part C plans. A Medicare Supplement policy will not do that. This unique feature of TFL means military retirees get comprehensive coverage with both Original Medicare and Medicare Advantage plans. Buying a separate Medigap policy when you have TFL is like buying a second car when you already have perfect transportation.
We’ve helped military retirees who were paying $3,000+ annually for Medigap policies they absolutely didn’t need. That’s $30,000 over 10 years for duplicate coverage.
The specialist difference: When we work with military retirees, the first question we ask is about their TRICARE for Life status. Generic advisors often don’t even know what TFL is, let alone how it integrates with Medicare.
6. Medicare Advantage (Part C) with TRICARE for Life: A Powerful Combination
This is where many military retirees can significantly enhance their benefits while keeping their Part B premiums as low as possible.
When you enroll in a Medicare Advantage (Part C) plan, it is your primary insurance, but TRICARE for Life continues to work exactly the same way as your secondary coverage or wraparound coverage, paying deductibles, copays and coinsurance. It’s important to know that when you have Part C you still have Medicare. As TRICARE’s official website confirms: “If you enroll in a Medicare Advantage Plan, you still have Medicare. Medicare is still your primary coverage, and TRICARE For Life is the second payer for TRICARE-covered services.” (Source: TRICARE.mil, https://tricare.mil/FAQs/TRICARE-with-Medicare/TRIMed_Advantage)
Why This Combination Works So Well
Minimizing Part B Premiums: Some Medicare options with premiums as low as $0 help keep your Part B costs as low as possible. With TFL covering your deductibles, copays and coinsurance, minimizing what you pay for Part B provides maximum value.
Additional Benefits Part C Provides that TFL Doesn’t Cover:
- Medicare options with premiums as low as $0 can provide access to additional benefits that enhance your overall healthcare coverage beyond what VA, Medicare, and TFL offer.
(Source: 2026 Medicare and You Handbook Page 62, Medicare.gov, https://www.medicare.gov/publications/10050-medicare-and-you.pdf)
Real Example:
A husband and wife both have TRICARE for Life. They enrolled in Medicare options with premiums as low as $0 that help them avoid overpaying for Part B.
The result:
- Combined Part B premium savings throughout retirement
- Additional healthcare benefits not available through TFL alone
- Enhanced coverage value
All while keeping their full TRICARE for Life benefits unchanged.
TRICARE for Life Prescription Coverage
TFL includes comprehensive prescription drug coverage, which operates differently from Medicare Part D:
Where You Can Fill Prescriptions:
- Military pharmacies (often $0 cost)
- VA pharmacies (if you’re also enrolled in VA care)
- Express Scripts home delivery
- Network retail pharmacies nationwide
Important Note About Medicare Part D: Since TFL provides creditable prescription drug coverage, you can delay Medicare Part D enrollment without penalty. If you choose a Medicare Advantage (Part C) plan with drug coverage, you can evaluate whether that option or Express Scripts provides better value for your specific medications. Many Medicare Advantage plans include Part D prescription coverage at $0 additional monthly premium, giving you another option to consider alongside your TFL prescription benefits.
7. Where Generic Advisors (and Even TFL Guidance) Get TRICARE for Life Wrong
We regularly clean up messes created by well-meaning generalist Medicare advisors who don’t understand military benefits. Here are the most common errors, and a crucial distinction regarding TRICARE for Life’s own advice:
Mistake #1: Recommending Medigap with TFL
- What they say: “You need Plan G to cover Medicare’s gaps.”
- The reality: TFL already covers those gaps better than any Medigap plan.
- The cost: $2,000-$4,000 annually in wasted premiums.
Mistake #2: Avoiding Medicare Advantage (Part C)
- What they say: “Advantage plans will interfere with your military benefits.”
- The reality: Medicare Advantage (Part C) plans also work with TFL and often provide additional benefits.
- The cost: Overpaying for Part B and missing access to additional benefits.
Mistake #3: Ignoring TFL Integration (The TFL Guidance Gap)
- What they say: “Let’s just set you up like any other Medicare client” or “You only need Medicare Parts A & B for TRICARE for Life.”
- The reality: While it’s true that you only need A & B to maintain TFL, this advice, even from well-meaning TRICARE representatives, often stops short of presenting the full spectrum of Medicare options available to military retirees. TFL staff are experts on TRICARE, not necessarily on the intricacies of Medicare and Medicare Part C plans and how they can enhance TFL benefits. Military retirees need strategies that account for TFL’s unique benefits and the potential added value of a Part C plan.
- The cost: Suboptimal coverage, missing strategies to avoid overpaying for Part B, and no access to additional benefits that Medicare options can provide without interfering with your TFL.
When we work with military retirees, we don’t just recommend Medicare plans. We develop strategies that optimize the integration between Medicare, TRICARE for Life, and any other benefits they might have.
Common Questions with Straight Answers
Q: “If Medicare pays first, why do I still need TFL?”
A: Because TFL eliminates your deductibles, coinsurance, and copays, giving you near-zero out-of-pocket costs. Without TFL, you’d be responsible for all of Medicare’s cost-sharing requirements.
Q: “Can I drop Medicare Part B if I move overseas?”
A: Absolutely not. Even if you live overseas where Medicare doesn’t provide coverage, you must maintain Part B to keep your TFL eligibility. This is a common misconception that costs military retirees their TFL benefits. TFL can also provide coverage overseas. (Source: TRICARE.mil, https://tricare.mil/Plans/HealthPlans/TFL/TFL_O)
Q: “Will a Medicare Advantage (Part C) plan interfere with my military healthcare on base?”
A: Not at all. You can continue using base clinics, hospitals, and pharmacies exactly as before. The Medicare Advantage (Part C) plan simply gives you additional civilian options.
Q: “What if I don’t like my Medicare Advantage (Part C) plan?”
A: According to TRICARE’s official newsroom, “Because you have TFL, you may disenroll from a Medicare Advantage Plan at any time. You can call Medicare or your Medicare Advantage Plan to request disenrollment. You’ll automatically be back in Original Medicare.”
Source: TRICARE Newsroom
8. Key Takeaways for Military Retirees
✓ Medicare Parts A & B are mandatory to maintain TRICARE for Life—never let them lapse
✓ Medicare + TFL creates unbeatable coverage with virtually no out-of-pocket costs
✓ Medicare Advantage (Part C) can enhance your benefits while keeping Part B premiums as low as possible
✓ Never buy Medigap if you have TFL—you’re paying for duplicate coverage
✓ Independent veteran specialists understand the integration better than generic Medicare advisors
✓ Annual reviews ensure you’re maximizing both benefits as plans and options change
✓ The right strategy keeps your Part B premiums as low as possible while maintaining world-class healthcare coverage
9. What’s Coming Next
Now that you understand how TRICARE for Life works with Medicare, you may have questions about Medicare Advantage plans. There’s a lot of criticism out there. Articles, studies, and “consumer advocates” claim these plans restrict care, deny services, and shortchange beneficiaries.
But after nearly two decades in Medicare and now working exclusively with veterans, I’ve discovered much of this criticism is outdated, misleading, or comes from sources with financial interests in keeping people in Original Medicare.
Chapter 4 will show you what the data actually reveals about Medicare Advantage.
We’ll examine the actual 2024 and 2025 data on approval rates, quality measures, and beneficiary satisfaction. You’ll see why 54% of Medicare beneficiaries have chosen Medicare Advantage, and why thousands of clients choose these plans to enhance their TRICARE for Life coverage while keeping Part B premiums as low as possible.
You’ll discover who’s really behind the anti-Medicare Advantage campaign and why their financial interests may not align with yours as a veteran. By the end of Chapter 4, you’ll have the facts you need to evaluate Medicare Advantage objectively.
Ready to separate fact from fiction? Let’s examine what the data reveals.
Questions about how TRICARE for Life integrates with your Medicare options? Throughout my Medicare career spanning nearly two decades, now working exclusively with veterans, I’ve helped thousands of military retirees navigate these integration decisions. Call us at 888-960-8387 (VETS) for expert guidance that shows you exactly what WE SPEAK VETERAN™ really means.