TRICARE For Life (TFL) is one of several TRICARE programs available to those who serve our country. TRICARE programs meet the Affordable Care Act requirements for minimum essential coverage.

Who's eligible and when

You are eligible for TRICARE For Life if you are:

  • Retired from one of the uniformed services (Army, Air Force, Navy, Marine Corps, Coast Guard, Public Health Service, National Oceanic and Atmospheric Administration, National Guard and its reserves) and
  • Eligible for premium-free Medicare Part A and enrolled in Medicare Part B, even if you are currently employed. You are eligible on the date that you have both Parts A and B.

Note: Contact TFL if you are not eligible for premium-free Part A to see if you qualify to remain in the TRICARE plan for active duty service members.

Who’s covered

Those listed above, including Medal of Honor recipients, and their eligible family members who are registered in the Defense Enrollment Eligibility Reporting System (DEERS).

Who pays

There are no TFL plan premium costs. However, you may pay a deductible and/or copayment for services depending on where and with whom you seek service. See the Tricare for Life Handbook for more details.

Who can have TFL, Medicare and other medical plan coverage

You can be enrolled in all three of these plans at the same time, regardless of whether your UC-sponsored Medicare plan is an HMO (e.g., Kaiser Senior Advantage, Health Net Seniority Plus); a Part D plan (e.g., Blue Shield Medicare PPO, High Option); or an HMO, Medigap or prescription drug plan through OneExchange. The coverage you have will affect how you are reimbursed.

How the plans work together

TRICARE for Life is managed by the Department of Defense. Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). These two agencies work together to coordinate benefits, including working with your UC-sponsored group Medicare plan or your OneExchange plan.

TFL is typically the last payer when a person is covered by several plans. However, TFL may cover medical services outside the United States, and may offer other advantages (such as less expensive prescriptions) over your UC plan. When this is the case, TFL is the primary payer. You are then responsible for any amount exceeding the TFL-allowable charge, in addition to your deductible and any co-payments.

How to get TFL claims paid

If you are enrolled in TFL, Medicare, and a UC-sponsored or OneExchange medical plan, your doctor will file a claim with Medicare first. Once Medicare has paid its portion of the claim, it will forward the claim to your UC medical plan or OneExchange carrier.

If part of the claim remains unpaid after UC or the OneExchange plan has paid its portion, you’ll need to forward the remainder of the claim to TFL yourself. For details about how to do this, please contact TRICARE customer service at (866) 773-0404 or tricare4u.com.

If you are working: the UC employee group medical plan pays first, Medicare pays second, and TFL pays last.

If you are retired: Medicare pays first, the UC-sponsored or OneExchange plan pays second, and TFL pays last.

If you wish to see any Medicare doctor

If you need, or would prefer, non-emergency care outside your HMO network, you have two options. You may:

  • Suspend your UC coverage and use Original Medicare (in conjunction with TFL or not) or
  • Enroll in a UC or OneExchange Medicare plan that allows you to see any provider. UC’s plans include the Blue Shield Medicare PPO (with or without prescription drugs) and the Blue Shield High Option Plan. If you’re a retiree outside California and would like to learn more about OneExchange, please see https://medicare.oneexchange.com/uc.

Suspending your UC-sponsored medical coverage

You may suspend your UC-sponsored Medicare plan if you have other creditable coverage (e.g., through a spouse’s plan, MediCal, Medicaid or Covered California) or if you wish to enroll in Original Medicare.

When you suspend your medical coverage, your family members’ coverage will also be suspended and any Part B reimbursement you were receiving will stop. If you have family members covered on your UC plan, check to be sure they are also covered by your military plan before you suspend UC coverage.

To suspend your Medicare plan coverage:

  • Fill out and return the UBEN 100 form by the 15th of the month to suspend coverage on the first of the following month, or
  • During Open Enrollment, go to At Your Service Online. You will receive a confirmation statement of any changes you make.

If you are enrolled in an HMO, fill out the UBEN 101 form to disenroll from your current HMO. This is not required if you are leaving a Blue Shield plan.

Re-enrolling in UC-sponsored medical coverage

If you suspend your UC coverage, you will have the opportunity to re-enroll.

  • If you lose TFL coverage involuntarily (for example, if you divorce and were married for less than 20 years), you have 31 days from the date you lose coverage to re-enroll in a UC-sponsored medical plan. You’ll need to provide UC with evidence of your TFL coverage, including who was enrolled and when your coverage started and ended.
  • If you did not lose TFL coverage involuntarily, you can re-enroll in a UC-sponsored medical plan during UC’s next Open Enrollment. Open Enrollment is usually in November; coverage is effective January 1. You must have continuous medical coverage through December 31 and you will be asked to provide documentation for you and your eligible family members.

To re-enroll, you’ll need to fill out and return the UBEN 100 form, including your coverage documentation, and complete a form to assign Medicare to your UC medical plan. If you have questions on suspending or re-enrolling, please contact the Retirement Administration Service Center (RASC) at (800) 888-8267.