News | Dec. 22, 2021

TRICARE For Life: Choosing Your Provider Option

By TRICARE Communications

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. 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.

Medicare Participating Providers
As described in the TRICARE For Life Handbook, Medicare participating providers accept the Medicare-allowed amount as payment in full. They’ll also file claims with Medicare for care you receive. After Medicare pays its portion, it will forward the claim to Wisconsin Physicians Service (WPS), which is the TFL contractor. WPS is responsible for processing and paying TRICARE’s portion of claims for TRICARE beneficiaries, who also have Medicare. When the care you receive is a benefit of Medicare and TRICARE, you’ll have no out-of-pocket costs.

To find a Medicare provider near you, you can:  Medicare Non-participating Providers
You may choose to see a Medicare non-participating provider. These providers don’t accept the Medicare-allowed amount as payment in full. They may also charge up to 15% above the Medicare-allowed amount for your health care services.  
 
“This shouldn’t be a concern for you because TRICARE covers that additional 15%,” said Anne Breslin, the TFL program manager at the Defense Health Agency. “No matter whether you see Medicare participating provider or a Medicare non-participating provider, your costs will be the same.”
 
Opt-Out Providers
You can also get care from providers who opt out of the Medicare program. Opt-out providers aren’t held to the Medicare or TRICARE-allowed amounts. So, you could have significant out-of-pocket costs if you get care from these providers. Before you choose this option, you should know all the costs for which you’ll be responsible.
 
Opt-out providers don’t take part in Medicare, so they can’t bill Medicare. Medicare also can’t pay for health care services you get from them. When you see an opt-out provider, TRICARE will only pay up to 20% of the TRICARE-allowable amount. You’ll be responsible for billed charges, minus the amount paid by TRICARE.
 
Department of Veterans Affairs Providers
Are you eligible for both TFL and benefits through the Department of Veterans Affairs (VA)? Like opt-out providers, VA providers can’t bill Medicare, nor can Medicare pay for health care services that you get from a VA provider. As described in the TRICARE For Life Handbook, if you see a VA provider for non-service connected care, you’ll have significant out-of-pocket costs. TRICARE can only pay up to 20% of the TRICARE-allowable amount. So, care at a VA facility may leave you responsible for the rest of the costs. What you pay depends on whether or not the care you receive is for a service-connected illness or injury. You’ll pay nothing when you get non-service connected care from Medicare providers and the care you receive is a benefit of Medicare and TRICARE.
 
If you choose to seek care from a VA provider, you can confirm your coverage details with the TFL contractor. They’ll let you know what TRICARE will cover.
 
Getting Care at Military Hospitals and Clinics
You can get care at any military hospital or clinic if space is available. You may also be able to use TRICARE Plus, as described in the TRICARE and Medicare: Turning Age 65 Brochure. This program allows certain beneficiaries to enroll at a military hospital or clinic and have priority access to primary care.
 
Overseas Providers
If you have TFL and live overseas, you may generally use any civilian provider and get care at military hospitals and clinics if space is available. But be prepared to pay up front for services and submit a claim. You’ll need to send your claims to the TRICARE Overseas Program claims processer, International SOS Government Services, Inc. While overseas, TRICARE is the primary payer unless you have other health insurance.
 
Keep in mind, you may have significant costs for your health care if you get care from VA or opt-out providers. Be sure to ask your provider if they’re participating, non-participating, or opt-out. Or, look them up on the Medicare website. To learn more about TFL, go to the TRICARE For Life page. And check out TFL episodes from the “Getting to Know TRICARE” podcast. 
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
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
A nurse speaks with patient

How to Choose Between TRICARE Prime and TRICARE ...

News
Dec. 02, 2021

TRICARE Open Season is your yearly opportunity to review your current benefits. It’s a time to make changes to...
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.