Chapter 3: TRICARE for Life and Medicare

If you are eligible for TRICARE For Life, Medicare Part A and Part B must be active. Part C and Part D are not required for TFL. For a service covered by both programs, Medicare generally pays first and TRICARE pays last. Your result can be different when a service is covered by only one program, or when you use a Medicare Advantage plan with its own network and claim rules.^[1][2]

1. Who needs TRICARE For Life?

TRICARE For Life is Medicare-wraparound coverage for people who are TRICARE-eligible and have Medicare Part A and Part B. Eligibility comes from your military status or qualifying family relationship; it is not the same program as VA health care. Confirm your TRICARE status with the Defense Health Agency if you are unsure.^[2]

• You are eligible for TRICARE and TFL under the military program's rules.^[2]
• Medicare Part A and Part B are both active. Keeping only Part A is not enough for TFL.^[1]
• You continue paying the Part B premium that applies to you. TFL does not replace that Medicare requirement.^[2][7]
• You understand that Part C and Part D are optional from TFL's perspective.^[1]

2. How Medicare and TFL coordinate

With Original Medicare, the provider files with Medicare first. Medicare processes the claim, and TRICARE For Life then considers the remaining amount under its own rules. TRICARE says it pays last when both programs cover the service. This is coordination of benefits, not a promise that every bill from every provider will have a zero balance.^[2][9]

Coverage, authorization and claim requirements still matter. Ask the provider and the plan or TRICARE before care when the situation is unclear.

3. What changes if you choose Medicare Advantage?

Medicare Advantage is Medicare Part C. It is optional for a TFL beneficiary. If you choose it, the plan's service area, provider network, referrals, prior authorization, copayments, deductibles and yearly out-of-pocket limit shape how Medicare-covered care is accessed. TRICARE's official Q&A says nonemergency health services generally must come from the Medicare Advantage plan's network, copayments may be due at the time of service, and you may need to file paper claims for TRICARE reimbursement.^[1][10]

A Medicare Advantage plan does not by itself remove your TFL eligibility, but it can change how a nonemergency visit is arranged and billed. Before using a new doctor, hospital or military treatment facility, ask the facility, the plan and TRICARE which network and claim path applies. Keep the plan's Evidence of Coverage and TRICARE claim instructions.^[1]

4. The claim path, step by step

1. Check the care route before the appointment With Original Medicare, confirm that the provider accepts Medicare. With Medicare Advantage, confirm the plan network and whether a referral or prior authorization is required. For nonemergency care, do not assume that a provider outside the plan's network will be covered.^[1][4]
2. Give the provider the right cards and information Tell the office that you have Medicare and TFL, or Medicare Advantage and TFL. Ask who will submit the claim and whether the office expects a copayment at the visit.^[1][2]
3. Let Medicare or the plan process the claim Original Medicare claims normally start with Medicare. A Medicare Advantage claim starts with the plan. The plan's rules determine covered services, authorization and cost sharing before TFL reviews any TRICARE-covered balance.^[1][2]
4. Follow up on any TRICARE claim With Medicare Advantage, TRICARE says you may need to file a paper claim for reimbursement. Keep the explanation of benefits, receipts and claim instructions instead of assuming the claim crossed over automatically.^[1]

5. Part B premiums and plan costs

For 2026, CMS lists a standard Medicare Part B premium of $202.90 per month and a Part B deductible of $283. Some beneficiaries pay a different premium because of income or a late-enrollment penalty. Those are 2026 figures; verify current amounts at Medicare.gov when you make a decision.^[7][4][8]

A Medicare Advantage plan premium is separate from Part B. Some plans may have a $0 plan premium, and some plans in some counties and years may offer a Part B premium reduction. The reduction is plan-specific, not universal, and it does not remove the plan's network, deductible, copayment, authorization or annual out-of-pocket rules. Read the plan materials and compare the complete package.^[3][4][5]

6. Do you need Medigap or Part D?

TFL can already pay certain Medicare cost sharing for services that both programs cover. That means a private Medicare Supplement policy may add less than a generic advisor expects, but the right comparison depends on your situation, policy terms and the care you use. Do not buy a supplement based only on a standard recommendation; compare it with your TFL benefits and ask how claims would work.^[2][3]

You do not need Medicare Part D to keep TFL. TRICARE's Pharmacy Program remains available to TFL beneficiaries. If you also have VA prescription coverage, Medicare identifies VA and TRICARE drug coverage as creditable coverage for Part D; keep the coverage notice and check the timing rule if that coverage ends. A Medicare Advantage plan may include Part D, so compare the formulary, pharmacies and costs with the prescription route you actually use.^[1][6]

7. TFL is not the same as VA health care

Many veterans use both systems, but VA health care and TFL have different eligibility and billing rules. The VA says other health insurance does not change the VA health care benefits you can get, and you generally choose which benefits to use each time you receive care. Medicare and VA cannot both pay for the same item or service.^[11][9]

For non-VA community care, VA authorization is required before a veteran receives the care in most situations. Emergency care at a non-VA facility has additional requirements, including using an emergency department and notifying VA within 72 hours. These VA rules are separate from a Medicare Advantage plan's network and authorization rules.^[12][13]

8. A practical TFL and Medicare checklist

1. Confirm your status Verify that you are eligible for TFL and that both Part A and Part B are active. If you are approaching 65, start the Medicare process early enough to avoid a coverage gap.^[1][14]
2. Protect Part B timing Do not treat TFL like VA health care or employer coverage when deciding whether to delay Part B. Review the Initial Enrollment Period and any Special Enrollment Period with Social Security or a SHIP counselor.^[8][14]
3. Compare Original Medicare and Medicare Advantage Compare provider access, networks, referrals, authorizations, copayments, prescriptions, plan premiums, Part B premium reductions and annual out-of-pocket limits. Consider how each choice works with TFL in your county.^[4][10][3]
4. Confirm the claim process Ask the provider and TRICARE whether claims cross over or whether you must submit paperwork. Save every explanation of benefits and receipt.^[1][2]

For a broader overview, read the TRICARE For Life and Medicare guide, the VA health care and Medicare guide, and the Veterans Medicare FAQ. If you want to discuss plan choices, you can book a call with Veterans Advantage Financial®. We are an independent insurance agency, not part of or endorsed by Medicare, CMS, VA, TRICARE, Social Security or any government agency.