Yes, TRICARE is secondary to Medicare for nearly all care received in the United States. When you have both, Medicare pays its portion first, then automatically forwards the claim to TRICARE for processing. This arrangement is called TRICARE For Life (TFL), and it functions as a Medicare wraparound, picking up most of the costs that Medicare doesn’t cover. The result is that many beneficiaries pay little to nothing out of pocket for covered services.
How the Payment Order Works
For care in the U.S. and U.S. territories, the process is straightforward. Your provider files the claim with Medicare. Medicare pays what it covers, then the claim is automatically forwarded to the TRICARE For Life claims processor. TRICARE then pays the provider directly for any remaining TRICARE-covered charges. You don’t need to file anything yourself.
If you also carry other health insurance, the order changes slightly depending on the type. With employer-sponsored insurance through a current employer, that insurance pays first, Medicare pays second, and TRICARE pays last. If your other insurance isn’t tied to current employment (like a retiree plan from a former employer), Medicare pays first, that other insurance pays second, and TRICARE pays last. By law, TRICARE always pays after all other health insurance except Medicaid, TRICARE supplement plans, and a few other specific exceptions.
When TRICARE Becomes the Primary Payer
There are important situations where TRICARE flips to primary payer and covers your care directly.
- Overseas care: Medicare does not cover services outside the United States. If you live or travel overseas, TRICARE becomes the primary payer and you’re responsible for TRICARE’s annual deductible and cost-shares.
- Services Medicare never covers: Some services are a TRICARE benefit but are never covered under Medicare. In those cases, TRICARE processes the claim as primary payer with its own deductibles and cost-shares applied.
- Exhausted Medicare benefits: If a service is normally covered by both programs but you’ve used up your Medicare benefit for the year, TRICARE steps in as primary. For example, TRICARE becomes primary payer for inpatient hospital care beyond 150 days.
Skilled Nursing Is a Good Example
Skilled nursing facility care illustrates how the two programs work together over time. Medicare covers the first 100 days of a skilled nursing stay (with cost-sharing starting on day 21). After that, Medicare coverage runs out. TRICARE has no day limit on skilled nursing as long as the care is medically necessary, but you’ll need a pre-authorization starting on day 101. So for the first 100 days, Medicare is primary and TRICARE covers the gaps. After that, TRICARE takes over as primary.
Filing Claims in Different Situations
For routine care in the U.S., the system is almost entirely hands-off. Your provider submits to Medicare, and the claim crosses over to TRICARE automatically. You don’t need to call anyone or submit paperwork.
Two situations require you to take action. If you receive care overseas, you need to file a claim directly with the TRICARE Overseas Program Contractor, which can be done online through their secure claims portal. And if you have Medicare, TRICARE, and a third insurance plan, you’ll need to file a paper claim with the TRICARE For Life contractor after both Medicare and your other insurer have processed their portions.
Keeping Your TRICARE For Life Coverage
TRICARE For Life isn’t a plan you enroll in separately. It kicks in automatically when you meet two conditions: you’re eligible for TRICARE (as a military retiree or qualifying family member) and you’re enrolled in both Medicare Part A and Part B. The critical requirement is Part B. If you drop Medicare Part B or decline to enroll, you lose TRICARE coverage. The Part B premium is a real cost, but for most military retirees the math works strongly in favor of keeping it, since TFL then covers nearly all remaining expenses.
Out-of-Pocket Costs
Because TRICARE pays after Medicare, most of your cost-sharing from Medicare gets picked up. The practical effect is that your largest ongoing expense is usually your Medicare Part B premium rather than bills from doctors or hospitals. TRICARE For Life also has a catastrophic cap of $3,000 per family, which limits your total annual out-of-pocket spending on TRICARE cost-shares regardless of how much care you need.
For overseas care, where TRICARE is primary, you’ll pay TRICARE’s standard deductible and cost-shares, which are higher than what most TFL beneficiaries experience domestically. That same $3,000 family catastrophic cap still applies.
VA Care and TRICARE
If you’re a veteran who also uses VA healthcare, the systems operate independently. VA facilities have participated as TRICARE network providers since 1995 and can see TRICARE beneficiaries on a space-available basis, but veterans receiving VA care for service-connected conditions are covered under the VA system, not through the Medicare-TRICARE coordination. VA care for TRICARE-eligible family members or for non-VA-covered services is available only when it won’t delay or deny access to veterans who are the VA’s primary patients.