News | May 27, 2021

Eligible for TRICARE For Life? What This Means for Your Family’s Coverage

By TRICARE Communications

Will you be turning age 65 this year? You’re on your way to an important milestone in your life. You’re also a step closer to becoming eligible for Medicare and TRICARE For Life (TFL). Once you have Medicare Part A and Part B, you’ll automatically have TFL. Of course, if you have family members—like a younger spouse or children—enrolled in a TRICARE plan, you may be wondering if your TFL eligibility may impact their coverage.
 
“One of the key things to know about TFL is that it’s an individual entitlement,” said Anne Breslin, TRICARE For Life program manager at the Defense Health Agency. “This means coverage is only for the beneficiary who is eligible for Medicare and TRICARE. Therefore, family members who aren’t eligible for Medicare remain eligible for TRICARE Prime or TRICARE Select.”
 
Here’s a look at what you need to know about TFL and what happens to your family’s TRICARE coverage once you become eligible for TFL benefits.
 
Who qualifies for TFL?
First, it’s important to understand how TFL works with Medicare and who’s eligible for it. TFL is Medicare-wraparound coverage. This means that Medicare pays first for health care services covered by both Medicare and TRICARE. TFL then pays the remaining amount. When you get care that’s covered only by TFL (for example, TRICARE covered services received overseas), TRICARE processes your claim as the primary payer.
 
To be eligible for TFL, your Defense Enrollment Eligibility Reporting System, or DEERS, record must reflect your eligibility for TRICARE and your entitlement to Medicare Part A and Part B. You may be eligible for Medicare if you’re:  
You’ll need to sign up for Medicare a few months before the month you turn age 65. As stated in the TRICARE and Medicare Turning Age 65 Brochure, “Your birth date determines when you become entitled to Medicare and when you should sign up for Medicare Part A and Part B.”
 
Does your birthday fall on the first day of the month? If so, you become eligible for Medicare on the first day of the month before you turn age 65. You should sign up for Medicare between two and four months before you turn age 65.
 
If your birthday falls after the first day of the month, you become eligible for Medicare on the first day of the month you turn age 65. Sign up for Medicare between one and three months before the month you turn age 65.
 
Your TFL coverage begins on the first day you have both Medicare Part A and Part B.
 
Now, what happens to my family’s coverage once I have TFL?
Nothing. The good news is your family’s existing TRICARE coverage doesn’t change. Your spouse can remain in his or her TRICARE plan. And if you have children, they remain in their current plan until they change plans or lose TRICARE eligibility.
 
Medicare and TFL are individual entitlements. However, becoming eligible for Medicare is one of many TRICARE Qualifying Life Events (QLEs) that apply to your family members. A QLE opens a 90-day period for you and your family to make eligible enrollment changes outside of TRICARE Open Season. For example, if your spouse wanted to switch from TRICARE Prime to TRICARE Select, this is the time to do so. You can learn more about QLEs in the TRICARE Qualifying Life Events Fact Sheet.
 
Keep in mind, there aren’t any enrollment forms or fees for TFL coverage. But you must pay Medicare Part B premiums to remain eligible for TFL. If you and your spouse had enrollment fees for your TRICARE Prime or TRICARE Select coverage, your spouse’s enrollment fee will be reduced when you have TFL.  
 
“Your spouse’s enrollment fee changes from the family rate to the individual rate once you have TFL,” said Breslin. “However, if you and your spouse have one or more children who are also enrolled in a TRICARE plan, the enrollment fee stays at the family rate.”
 
Do you have questions about enrollment fees? You can check out the TRICARE Compare Cost Tool or contact your TRICARE contractor to learn more.
 
As you or a family member becomes eligible for Medicare and TFL, it’s important you know how TFL works. The TRICARE For Life Handbook, TRICARE and Medicare Turning Age 65 Brochure, and TRICARE and Medicare Under Age 65 Brochure are useful resources to help you learn more about eligibility, costs, what’s covered, and more.
Doctor sitting at desk

Need Help Finding a TRICARE Network Provider?

News
Jan. 11, 2022

The new year has begun. It’s a great time to renew focus on your health. Did you put off seeing a doctor in...
Read More
Graphic of the TRICARE Choices for National Guard and Reserve Handbook

In the National Guard or Reserve? Learn About Yo...

News
Dec. 28, 2021

Are you a National Guard or Reserve member? Check out the TRICARE Choices for National Guard and Reserve...
Read More
There are two main categories of Medicare providers: participating and non-participating. A third category is opt-out providers, which are your most expensive option. If you wish to make the best choice for your coverage, it’s important that you learn the differences between each provider type.

TRICARE For Life: Choosing Your Provider Option

News
Dec. 22, 2021

Do you have medical coverage under the TRICARE For Life (TFL) program? Will you soon be eligible for TFL? If...
Read More
MHS Nurse Advice Line logo

Need Health Advice at Home? Chat With a Nurse 24/7

News
Dec. 20, 2021

With the threat of flu season added to the ongoing COVID-19 pandemic, you might not want to go to the doctor’s...
Read More
Prescription pill bottles sit on a shelf

What You Need to Know About New TRICARE Pharmacy...

News
Dec. 15, 2021

As of Dec. 15, CVS Pharmacy is a part of the TRICARE retail pharmacy network. At the same time, Walmart, Sam’s...
Read More
Hands holding pill bottle

How TRICARE Pharmacy Network Changes Will Affect...

News
Dec. 13, 2021

Have you heard about the changes coming to the TRICARE retail pharmacy network starting Dec. 15? CVS Pharmacy...
Read More
Service member hugs children

Act Now: TRICARE Open Season Ends Dec. 13

News
Dec. 09, 2021

Did you know TRICARE Open Season ends on Monday, Dec. 13? This is your last opportunity, if you so choose, to...
Read More
Woman on laptop

Researching Your 2022 Health Care Costs? Here Ar...

News
Dec. 07, 2021

Did you know that we’re currently in TRICARE Open Season? This is the time when eligible TRICARE beneficiaries...
Read More

Jan. 11, 2022

Need Help Finding a TRICARE Network Provider?

The new year has begun. It’s a great time to renew focus on your health. Did you put off seeing a doctor in 2021? If so, now is your time to act. Regular checkups are critical to screening for diseases and preventing future health problems. And TRICARE is here to help you find the right doctor.

Dec. 28, 2021

In the National Guard or Reserve? Learn About Your Health Care Options

Are you a National Guard or Reserve member? Check out the TRICARE Choices for National Guard and Reserve Handbook.

Dec. 22, 2021

TRICARE For Life: Choosing Your Provider Option

Do you have medical coverage under the TRICARE For Life (TFL) program? Will you soon be eligible for TFL? If so, it’s important to become familiar with your choices of Medicare providers, whatever your needs may be.

Dec. 20, 2021

Need Health Advice at Home? Chat With a Nurse 24/7

With the threat of flu season added to the ongoing COVID-19 pandemic, you might not want to go to the doctor’s office for a minor health issue. And with the Military Health System (MHS) Nurse Advice Line, you may not have to. According to the Centers for Disease Control and Prevention, one of the best ways to prevent flu and COVID-19 is to avoid contact with people who are sick. With the MHS Nurse Advice Line, you can get health advice 24/7 from a registered nurse from the comfort of your home.

Dec. 15, 2021

What You Need to Know About New TRICARE Pharmacy Network Options

As of Dec. 15, CVS Pharmacy is a part of the TRICARE retail pharmacy network. At the same time, Walmart, Sam’s Club, and some community pharmacies are no longer a part of the TRICARE network. What does this mean for you? Although the list of retail network pharmacies has changed, you can still get the medications you need.

Dec. 13, 2021

How TRICARE Pharmacy Network Changes Will Affect TRICARE For Life

Have you heard about the changes coming to the TRICARE retail pharmacy network starting Dec. 15? CVS Pharmacy is joining the network on that date. At the same time, Walmart, Sam’s Club, and some community pharmacies are leaving the network. If you’re a TRICARE For Life (TFL) beneficiary, you may be wondering how these changes affect the coverage of your current drugs. They don’t.

Dec. 9, 2021

Act Now: TRICARE Open Season Ends Dec. 13

Did you know TRICARE Open Season ends on Monday, Dec. 13? This is your last opportunity, if you so choose, to enroll in or change your health plan. Any changes you make to your coverage during open season will take effect Jan. 1, 2022.

Dec. 7, 2021

Researching Your 2022 Health Care Costs? Here Are 7 Terms to Know

Did you know that we’re currently in TRICARE Open Season? This is the time when eligible TRICARE beneficiaries can change or enroll in health plans for the upcoming year. But choosing a plan often means encountering a few unfamiliar health care terms.

Dec. 2, 2021

How to Choose Between TRICARE Prime and TRICARE Select

TRICARE Open Season is your yearly opportunity to review your current benefits. It’s a time to make changes to your health plan based on your personal needs. Dec. 13 marks the end of open season, so it’s important to make your decisions now. But which plan will best meet your needs in the new year?

Dec. 2, 2021

COVID-19 Booster Shots: Check Your Eligibility

Are you wondering if you’re eligible for a COVID-19 booster shot? The answer is yes, if you’re age 18 or older. The Centers for Disease Control and Prevention (CDC) recently expanded eligibility for COVID-19 vaccine booster shots as further described below.

Learn More about COVID-19 and the COVID-19 Vaccine.