TRICARE For Life (TFL) & Veterans Affairs (VA) Benefits

TRICARE For Life (TFL)

TRICARE For Life (TFL) is a program that provides health coverage to all military retirees, their spouses, survivors and other qualified dependents. TFL:

• Has no premiums or copayments for Medicare-covered services other than the Part B Medicare premium
• Provides supplemental medical coverage for all Medicare Part A and B services
• Includes prescription drug coverage

How TFL and Medicare Coordinate

If you have Medicare and TFL, Medicare is the primary insurer and TFL is the secondary insurer for services covered by both plans. For example, after a Medicare-covered doctor’s visit, Medicare would pay 80% of the Medicare-approved amount and TFL would pay the remaining 20%, up to its allowable charge.

If you have other supplemental health insurance in addition to Medicare and TFL, Medicare pays first, followed by your other insurance and then by TFL. For example, after a Medicare-covered doctor’s visit, Medicare would pay first and your other health insurance would pay second. If there was still a balance you wanted TFL to pay, you would need to file a claim with the TFL contractor online or by phone at 1-866-773-0404 or 1-866-773-0405 (TTY/TDD). Note: The TFL contractor covering California is Wisconsin Physicians Services, Inc.

For services covered by TFL but not Medicare (such as services received overseas), TFL is the primary payer and you are responsible for the TFL standard annual deductible and cost sharing, unless you have other health insurance.

For services covered by Medicare but not TFL, Medicare is the primary payer. If there is a balance after Medicare pays, you are responsible for it unless you have other supplemental health insurance. TFL will not cover any part of these services.

For services not covered by TFL or Medicare, you are responsible for the cost, unless you have health insurance that covers these services.

TFL beneficiaries must be enrolled in Medicare Parts A and B. For more information, call 1-866-773-0404, visit the TFL website or contact your local Health Insurance Counseling and Advocacy Program (HICAP). Fact sheet subscribers can see our fact sheet People with Medicare and TriCare for Life.

Veterans Affairs (VA)

Veterans of any age, except those who have been dishonorably discharged, may apply for health care called the Medical Benefits Package at the Department of Veterans Affairs (VA). These plans have no premiums and provide:

These plans may also provide nursing home care, adult day health care, dental care and eyeglasses.

To receive benefits from the VA Medical Benefits Package, you must be a veteran, enroll in the VA health system and go to VA facilities.

The VA encourages enrolled veterans to retain any other health insurance they have, including Medicare and Medi-Cal. VA health benefits are established by federal law and regulations, and can change depending on how much funding congress approves each year.

If you are enrolled in the VA Medical Benefits Package and also have private health insurance or federally funded coverage through TRICARE, Medicare or Medi-Cal, you may use your existing coverage in addition to your VA health care benefits. The programs are independent and do not coordinate. As a result, you cannot use your Medicare card at a VA facility because the VA cannot bill Medicare. To use Original fee-for-service Medicare, you must go to doctors and facilities that accept Medicare assignment. You are responsible for paying all Medicare premiums, deductibles and coinsurance. The VA does not pay for these Medicare costs.

In addition, if you have other private health insurance, including a Medigap policy, the VA is required by law to bill your insurance carrier when you receive care for non-service-connected conditions.

To enroll in the Medical Benefits Package, complete VA Form 10-10EZ, which can be obtained from any VA health care facility, regional benefits office, online or by calling 1-877-222-VETS (8387). For more information, visit the VA website. Fact sheet subscribers can also see our fact sheet Medicare and Veterans Administration Medical Benefits Package (PDF).