How does TRICARE work with Medicare?
Last Updated : 09/27/20194 min read
Millions of military retirees and families get health insurance through TRICARE, the federal military health insurance program. TRICARE beneficiaries can generally receive services at military facilities, or at certain other medical facilities.
Many TRICARE retirees also qualify for Medicare. It’s important to understand how Medicare works with veterans’ health insurance to make the most of these hard-earned benefits.
What is TRICARE?
TRICARE provides health insurance to service people, their families, and retirees.
For active military members and dependents:
- The program generally centers medical care on military facilities.
- With prior authorization, or in emergencies, TRICARE may also cover health care from other providers.
How is TRICARE different from Medicare?
Medicare is also a federal health insurance program. Original Medicare, Part A and Part B, is for eligible people 65 and older, and those who qualify by disability before age 65. It’s not associated with veterans specifically, as TRICARE is.
As a Medicare beneficiary, you may have more flexibility when it comes to health-care providers. Under Original Medicare, you can see any provider who accepts Medicare assignment.
TRICARE and Medicare may work together in some cases to reduce medical bills for services not covered by one or the other.
How Medicare and TRICARE work together
If you’re a retired military beneficiary, you should enroll in Medicare Part A and B when you first qualify to keep your TRICARE benefits. If you’re still on active duty, and you’re eligible for Medicare Part A, you generally don’t have to sign up for Medicare Part B to keep your TRICARE benefits.
The way that Medicare and TRICARE work together depends upon the member’s military status.
For active duty service members, TRICARE generally:
- Pays for Medicare-covered expenses
- Pays your Medicare deductibles and coinsurance/copayments
- May cover some health care services that Medicare doesn’t cover
For retired service members, Medicare generally pays for Medicare-covered expenses.
Medicare usually doesn’t cover care you receive at military hospitals and other federal facilities.
If you get care through a non-military health provider, Medicare typically pays first. This means that Medicare will cover health-care expenses up to its own limits. After that, TRICARE may pay its share of covered expenses.
For a non-military provider, TRICARE may work similarly to any other supplementary second payer insurance policy you might have.
- For a short hospital stay, Medicare might cover everything but the inpatient deductible.
- TRICARE might pay the deductible.
You can still choose to use military medical facilities. When you do, TRICARE usually covers everything.
TRICARE with Medicare and other health insurance plans
Perhaps you’re a service member’s spouse, and you have additional health insurance besides TRICARE and Medicare. For example, maybe you have job-related health insurance.
In this case, your other health insurance generally pays first, and TRICARE may pay for services it covers that aren’t covered by the primary payer.
TRICARE with Medicare Supplement insurance plans or Medicare Advantage plans
Medicare prescription drug plans
TRICARE includes prescription drug coverage, so you may not need to enroll under Medicare Part D. Medicare Part D is prescription drug coverage, available through a stand-alone Medicare Part D prescription drug plan or a Medicare Advantage prescription drug plan.
If you’re enrolled in any type of Medicare prescription drug plan and in TRICARE, you may want to contact your plan, or TRICARE, to find out how they will coordinate benefits.
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