For most people, Medicare combined with TRICARE For Life (TFL) provides exceptionally thorough health coverage with minimal out-of-pocket costs. Together, they function like having Medicare plus a high-quality supplement plan, covering nearly all medical expenses for doctor visits, hospital stays, and outpatient care. You typically pay $0 for services covered by both programs. That said, there are a few notable gaps worth understanding, particularly around dental care, vision, and long-term custodial care.
How Medicare and TFL Work Together
TRICARE For Life acts as wraparound coverage that picks up where Medicare leaves off. When you see a doctor or get treated at a hospital, Medicare pays first as your primary insurance. TFL then steps in as the secondary payer and covers most or all of the remaining costs, including your Medicare deductibles and coinsurance.
To stay eligible for TFL, you must be enrolled in both Medicare Part A and Part B. This is non-negotiable. Even if you live overseas where Medicare doesn’t pay for care, you still need Part B to keep your TRICARE eligibility. The standard Part B premium is $185 per month in 2025, and that’s really your main recurring cost for this coverage combination. There’s no separate premium for TFL itself.
What You’ll Actually Pay Out of Pocket
For services covered by both Medicare and TRICARE, your cost is $0 in most situations. Medicare pays its share first, and TFL covers the rest. This includes doctor visits, hospital stays, ambulance services, outpatient procedures, and durable medical equipment. TFL even pays your Medicare deductibles: the $1,736 per-benefit-period hospital deductible and the $257 annual Part B deductible (2025 figures) are covered by TRICARE rather than coming out of your pocket.
There are a few exceptions. Chiropractic services, for example, leave you responsible for 20% of the Medicare-approved amount because TFL doesn’t cover TRICARE’s portion for that category. And if you see a provider who doesn’t accept Medicare assignment, TFL may pay up to 15% above the Medicare-approved amount, but anything beyond that could fall to you.
If you do end up with any TRICARE cost-sharing, the annual catastrophic cap is $3,000 per family. That’s the absolute maximum you’d pay in a calendar year for TRICARE-covered services. In practice, most TFL beneficiaries spend far less than that.
You Don’t Need a Medigap Plan
One of the most common questions TFL beneficiaries have is whether they should also buy a Medicare Supplement (Medigap) policy. The answer is no. TFL already functions as your Medicare supplement, covering the gaps that Medigap policies are designed to fill. Purchasing a separate Medigap plan would be redundant and a waste of money.
Prescription Drug Coverage
The TRICARE Pharmacy Program provides your prescription drug coverage, and it’s considered “creditable coverage,” meaning it pays at least as much as a standard Medicare Part D plan. A major advantage: the TRICARE pharmacy benefit has no monthly premium, while most Part D plans charge one.
If you’re considering enrolling in Medicare Part D anyway, compare costs carefully. Look at deductibles, copayments, and especially the prices for medications you currently take, since costs can vary depending on your specific prescriptions. If you do have both Part D and TFL, Medicare pays first and TRICARE pays last. And because your TRICARE pharmacy coverage qualifies as creditable, you won’t face a late enrollment penalty if you decide to sign up for Part D later.
Where TFL Falls Short: Dental and Vision
Routine dental and vision care represent the most noticeable gap in the Medicare-plus-TFL combination. Neither Medicare nor TRICARE For Life covers regular dental cleanings, fillings, dentures, or routine eye exams for glasses.
Military retirees and their survivors can enroll in dental and vision plans through the Federal Employees Dental and Vision Insurance Program (FEDVIP), which is administered by the Office of Personnel Management. These plans do carry premiums, and enrollment happens during the annual Federal Benefits Open Season or after a qualifying life event. If dental and vision care matter to you (and they should), FEDVIP is worth looking into as an affordable add-on.
Long-Term Care Is Not Covered
This is the biggest gap in TFL coverage and the one most likely to cause financial strain. TRICARE does not cover long-term care, which includes assistance with daily activities like bathing, dressing, and walking for people with prolonged illness, degenerative conditions, or cognitive decline. This type of care, sometimes called custodial care, is also largely excluded from Medicare.
TRICARE does cover skilled nursing care, which involves medical treatment provided by licensed professionals. But the kind of ongoing, non-medical support that many older adults eventually need in assisted living facilities or nursing homes is a separate category entirely. If long-term care is a concern, a standalone long-term care insurance policy or personal savings strategy is worth considering, because neither Medicare nor TFL will fill that gap.
Home Health Care Coverage
TFL does cover home health services when they’re medically necessary, following the same rules as Medicare. Covered services include part-time skilled nursing care, home health aide visits, physical therapy, speech therapy, occupational therapy, and medical social services. You’ll need pre-authorization, and the care must come from a participating home health agency.
For beneficiaries with more extensive needs, TRICARE’s Extended Care Health Option may provide additional home health services beyond what standard coverage includes.
Coverage When Traveling Overseas
Medicare only pays for care within the United States and U.S. territories. If you travel or live abroad, TFL becomes your primary payer. In that role, you’re responsible for TRICARE’s annual deductible ($150 per individual or $300 per family) and applicable cost-shares, rather than enjoying the $0 out-of-pocket that comes with domestic dual coverage.
International SOS serves as the TRICARE overseas contractor and can help you find providers, get authorizations, and file claims. If you spend significant time outside the U.S., this overseas coverage is a meaningful benefit that most Medicare-only beneficiaries don’t have.
The Bottom Line on Coverage Gaps
Medicare plus TRICARE For Life is one of the most comprehensive health coverage combinations available in the U.S. For standard medical care, your out-of-pocket costs are close to zero. You don’t need Medigap. You don’t need Part D unless your specific medications would cost less through a Part D plan. Your only guaranteed recurring expense is the $185 monthly Part B premium.
The real vulnerabilities are dental, vision, and long-term custodial care. FEDVIP can address the first two at a reasonable cost. Long-term care is the one area where TFL beneficiaries face the same financial exposure as everyone else, and it’s worth planning for separately.