TRICARE For Life Guide: 2026 Rates and Coverage

*Disclaimer: TRICARE.com is an independent reference site and is not the official TRICARE program or a government entity. For official policy and the most up-to-date program information, visit TRICARE.mil.*

## Quick answer TRICARE For Life (TFL) is Medicare-wraparound coverage for military retirees and their eligible family members who are entitled to Medicare Part A and Part B. It acts as a secondary payer, automatically covering most out-of-pocket costs (deductibles and coinsurance) that Medicare leaves behind, typically resulting in zero out-of-pocket costs for covered medical services.

## In detail TRICARE For Life is a unique benefit because it is "entitlement-based" rather than "enrollment-based." There is no enrollment fee and no separate application; if you are eligible and have Medicare Part A and B, you are automatically covered by TFL.

### How the Payments Work When you see a provider that accepts both Medicare and TRICARE, the billing process is seamless: 1. **Medicare** acts as the primary payer and pays its share first. 2. **TRICARE For Life** acts as the secondary payer, covering the remaining patient liability (deductibles and coinsurance). 3. **The Beneficiary** typically pays $0 for services covered by both programs.

*Note: If a service is covered by TRICARE but not Medicare (e.g., some overseas care), TRICARE acts as the primary payer, and you pay the applicable TRICARE deductible and cost-shares.*

### Coverage Requirements To maintain TFL coverage, you must: * Be registered in the **DEERS** (Defense Enrollment Eligibility Reporting System) database. * Be entitled to **Medicare Part A** (hospital insurance). * Be enrolled in and pay premiums for **Medicare Part B** (medical insurance).

### Costs and Fees (2026 Rates) * **Annual Enrollment Fee:** $0. * **TFL Monthly Premium:** $0 (However, you must pay your standard Medicare Part B monthly premiums to Social Security). * **Catastrophic Cap:** For TFL beneficiaries, the catastrophic cap is **$3,000 per family per calendar year (2026)** for TFL-covered services.

### Pharmacy Benefits TFL beneficiaries are automatically covered by the **TRICARE Pharmacy Program** administered by **Express Scripts**. You can use military pharmacies (usually $0 copay), home delivery, or retail network pharmacies.

## Who this applies to * **Military Retirees:** Retired members of the active component and Reserve component who are age 65 or older. * **Spouses/Widows:** Eligible spouses and unremarried surviving spouses of retired service members. * **Medically Retired Members:** Those retired for disability who become Medicare-eligible, regardless of age. * **Certain Disabled Beneficiaries:** Beneficiaries under age 65 who qualify for Medicare due to a disability or End-Stage Renal Disease (ESRD).

Common scenarios

### 1. Routine Specialist Visit John is a 68-year-old retired Army Sergeant First Class. He visits a cardiologist for a checkup. The Medicare-approved rate is $200. Medicare pays 80% ($160). TRICARE For Life automatically receives the claim and pays the remaining 20% ($40). **John's out-of-pocket cost: $0.**

### 2. Services Not Covered by Medicare (e.g., Overseas) Mary, a Navy retiree living in Italy, visits a local doctor. Medicare does not provide coverage outside the U.S. TRICARE For Life becomes the primary payer. Mary pays the TRICARE For Life annual deductible (approximately $150-$300 depending on rank/status) and then a 25% cost-share for the remainder of the visit.

### 3. Prescription Refill Robert needs a 90-day supply of a brand-name maintenance medication. He uses TRICARE Pharmacy Home Delivery (Express Scripts). In 2026, he pays a flat **$46 copay** for the 90-day supply. If he had used a military pharmacy, his cost would be **$0**.

## Related terms * **DEERS:** The database used to verify identity and TRICARE eligibility. * **Medicare Part B:** The portion of Medicare that covers doctor visits and outpatient services; required for TFL. * **Secondary Payer:** A health insurance plan that pays after the primary insurance has processed the claim. * **Express Scripts:** The private contractor that manages the TRICARE pharmacy benefit. * **T-5 Contract:** The current TRICARE regional contract (effective 2025) which transitioned West region management to TriWest Healthcare Alliance.

## Sources * TRICARE.mil official TFL page: https://www.tricare.mil/tfl * Defense Health Agency (DHA) - Medicare-wraparound: https://health.mil/ * Medicare.gov: https://www.medicare.gov/ * Express Scripts TRICARE Pharmacy: https://militaryrx.express-scripts.com/