Medicare Eligibility & TRICARE For Life Guide (2026) | TRICARE.com

The short answer is that **TRICARE For Life (TFL)** is a wrap-around coverage plan for military retirees and their dependents who are entitled to Medicare Part A and have Medicare Part B. Once you are enrolled in both Medicare and TRICARE, Medicare becomes your primary insurance, and TRICARE pays your remaining out-of-pocket costs for TRICARE-covered services.

*Note: TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy, visit TRICARE.mil.*

In detail

TRICARE For Life is automatic, secondary coverage that requires no enrollment forms or monthly premiums beyond what you pay for Medicare Part B. It is available worldwide, though it functions differently outside the United States.

### The Medicare Part B Requirement To remain eligible for TRICARE once you become eligible for Medicare (usually at age 65), you **must** have Medicare Part B. If you do not sign up for Part B during your Initial Enrollment Period, you will lose your TRICARE coverage until you enroll. * **Exception:** Active duty service members and their active duty family members are not required to have Part B to keep TRICARE, but they must enroll in Part B before the service member retires to avoid a break in coverage.

### How Coverage Works (Coordination of Benefits) How TFL pays depends on where you live and whether the service is covered by both programs: * **Services covered by Medicare and TRICARE:** Medicare pays its share first, and TFL pays the remaining deductible and cost-share. In most cases, you have $0 out-of-pocket. * **Services covered by Medicare but not TRICARE:** Medicare pays its share, and you pay the Medicare deductible and cost-share. * **Services covered by TRICARE but not Medicare:** TRICARE acts as the primary payer. You pay the TRICARE deductible and cost-shares (e.g., overseas care).

### 2026 Costs and Fees * **Enrollment Fees:** $0 (included as part of your retiree benefits). * **Monthly Premiums:** $0 (however, you must pay the standard Medicare Part B premium to the Social Security Administration). * **Deductibles:** You generally do not have a TRICARE deductible for services covered by Medicare. * **Catastrophic Cap:** For 2026, the catastrophic cap for retirees on TFL usually follows the TRICARE Select cap structure (approximately $4,300+ for Group A retirees, but varies by plan year — check TRICARE.mil for current rates).

### Pharmacy Benefits TFL beneficiaries are covered by the **TRICARE Pharmacy Program**, managed by **Express Scripts**. You do not need a Medicare Part D prescription drug plan. In fact, Medicare Part D is generally unnecessary for those with TFL.

Who this applies to

* **Retirees (and their spouses):** When they reach age 65 and become eligible for Medicare Part A. * **Disabled Beneficiaries:** Individuals under 65 who qualify for Medicare due to a disability or End-Stage Renal Disease (ESRD). * **Medal of Honor Recipients:** And their eligible family members. * **Survivors:** Spouses of deceased service members who transition to Medicare.

Common scenarios

### Scenario 1: Reaching Age 65 in 2026 John is a retired Navy veteran turning 65 in May 2026. He is currently on TRICARE Select. To transition to TFL, John signs up for Medicare Part B three months before his birthday. On May 1, his coverage automatically shifts to TRICARE For Life. When he sees his doctor for a $200 office visit, Medicare pays $160 (80%), and TFL pays the remaining $40 (20%). John's out-of-pocket cost is $0.

### Scenario 2: Seeking Care Overseas Sarah lives in Germany and has TFL. Because Medicare does not provide coverage outside the U.S. and its territories, TRICARE becomes the primary payer. Sarah must pay her TRICARE deductible ($150 for 2026) and a 25% cost-share for her medical bills, managed by the overseas contractor **International SOS**.

### Scenario 3: Under-65 Disability Mark is 55 and has been receiving Social Security Disability Insurance (SSDI) for 24 months. He becomes eligible for Medicare early. To keep his TRICARE Prime coverage from switching to TFL (or to keep TRICARE coverage at all), he must enroll in Medicare Part B immediately upon eligibility, even though he is not yet 65.

Related terms

* **DEERS:** The Defense Enrollment Eligibility Reporting System; the database that must be updated to show you have Medicare Part B. * **Dual Eligibility:** Being entitled to both Medicare and TRICARE benefits simultaneously. * **Part B Premium:** The monthly fee paid to Medicare (often deducted from Social Security checks) required to keep TFL. * **T-5 Contract:** The 2025/2026 regional contract transition—specifically affecting the West region managed by **TriWest**. * **Catastrophic Cap:** The maximum out-of-pocket amount you pay for covered medical services each calendar year.

## Sources * TRICARE.mil: [TRICARE For Life Official Overview](https://www.tricare.mil/tfl) * Medicare.gov: [Medicare and TRICARE Coordination](https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-agencies/medicare-tricare) * Defense Health Agency (DHA): [TFL Cost and Eligibility](https://health.mil)