TRICARE for Life (TFL) is Medicare-wraparound coverage for TRICARE beneficiaries eligible for Medicare Part A and enrolled in Medicare Part B. Medicare is the primary payer to TFL for all Medicare and TRICARE-covered benefits.
However, beneficiaries may need an authorization from Humana Military/ValueOptions® Federal Services if Medicare benefits are exhausted, or for care covered by TRICARE but not Medicare.
- File TFL claims first with Medicare.
- Medicare pays its portion and electronically forwards the claim to WPS/TDEFIC (unless the beneficiary has OHI).
- WPS/TDEFIC sends its payment for TRICARE-covered services directly to the provider. Beneficiaries receive Medicare Summary Notices and TRICARE Explanations of Benefits (EOBs) indicating the amounts paid.
- For services covered by both TRICARE and Medicare, Medicare pays first and TRICARE pays its share of the remaining expenses second (unless the beneficiary has OHI).
- For services covered by TRICARE but not by Medicare, TRICARE processes the claim as the primary payer. The beneficiary is responsible for the applicable TFL deductible and cost-share.
- For services covered by Medicare but not by TRICARE, Medicare is the primary payer and TRICARE pays nothing. The beneficiary is responsible for the applicable Medicare deductible and cost-share.
- For services not covered by Medicare or TRICARE: the beneficiary is responsible for the entire bill.
For more information about TFL, call WPS/TDEFIC at 1-866-773-0404
or visit TRICARE4u.com