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Beneficiaries who already are enjoying Medicare A and B coverage can avail Tricare for Life or TFL. But for that we need to understand what TFL is.

TFL- The Basics:

The Insurance provided by TFL is connected to the Medicare coverage. In other words this acts as a secondary insurance coverage for people who have chosen Medicare as their primary health insurance provider. TFL protection covers costs associated with co-payments, deductibles and co-insurances.

Eligibility:

  • Any individual who already is a Tricare beneficiary, who is eligible for Medicare, can avail of TFL.
  • In most cases people gain eligibility for Medicare once they attain the age of 65. However there are certain conditions under people do gain eligibility for Medicare before 65. Therefore eligibility for TFL is regardless of any age.
  • Though there is no enrolment fee for TFL, it is mandatory that the participant is already availing coverage under Part A and B of Medicare.

Benefits:

Tricare for Life covers the following benefits:

  • Ability to avail care from Medicare-approved healthcare provider.
  • No requirement for managed primary care like an HMO.
  • Availing facilities from military institutions.
  • Benefits may be supplemented with additional insurance coverage.
  • Additional coverage is available apart from those available from Medicare.

Claim Procedure:

A patient does not have to take the trouble to go through the TFL claims process, provide the following is done:

  • Claim is made by the patientís healthcare provider
  • Claim procedure is taken up by Medicare
  • Medicare carries the claim forward to Tricare for secondary payment.
  • Provided the service extended to the patient is covered by Tricare, TFL would make a co-insurance payment to the provider.

Limitations:

There are a few limitations to the eligibility to TFL:

  • Having TFL coverage will not ensure that one will not have to pay any expenses.
  • TFL can only be used as a supplementary coverage to Medicare members who are eligible for Tricare.
  • There can be situations wherein we need to pay for healthcare services out-of-pocket, even if we are covered by Medicare and Tricare.

Some Exceptions:

  • It is important to note that Medicare does not cover any healthcare expenses incurred outside the United States. However the individual will receive the coverage under Tricare and thereby TFL will also cover. For this the patient will have to pay the necessary deductibles required.
  • Another important point of exception is that if one receives services from a provider who has moved out of the Medicare network, then the member would require pay expenses on his own. Tricare would only pay the portion that it covers, but rest of the expenses (which Medicare would have covered if the provider would have been under Medicare network) will have to be borne by the patient.
  • There are certain Medicare services which are not covered by Tricare. Chiropractic treatment is one of such services. E.g. if one is getting coverage for chiropractic treatment through Medicare services, then one will need to avail Part B coverage for which the deductibles and co-insurance involved will not be covered under TFL since this is not covered by Tricare.
  • There are certain medical services like cosmetic surgery which are neither covered by Medicare nor by Tricare. Expenses for these have to be borne by self.

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