How TFL and Medicare split the bill
TRICARE describes TFL as Medicare-wraparound coverage: Medicare pays its share, then sends the claim to TRICARE's TFL claims processor, which pays most of what's left for services both programs cover. You don't pay TRICARE an enrollment fee, but you do pay the Part B premium ($202.90 a month for most people in 2026).
| Your situation | Who pays first |
|---|---|
| Retired, with Medicare and TFL | Medicare, then TRICARE |
| You or your spouse still work and have job-based group coverage | Employer plan, then Medicare, then TRICARE |
| A service Medicare doesn't cover but TRICARE does | TRICARE pays as primary; you pay its deductible and cost shares |
| Care outside the U.S. and its territories | TRICARE (Medicare doesn't pay overseas) |
TRICARE also pays Part B excess charges (up to 15% above the Medicare-approved amount) for TRICARE-covered services from providers who don't take Medicare's amount as full payment.
What it means in Ohio
- Any Medicare provider. TFL doesn't add a network. Hospitals and doctors across Ohio that accept Medicare work with TFL, and so do providers in other states when you travel.
- VA care is different. VA can't bill Medicare. For VA care not related to your service, TRICARE pays at most 20% of its allowable amount, so TRICARE warns you may owe the rest.
- Prescriptions. TRICARE pharmacy coverage continues, including military pharmacies such as the one the 88th Medical Group runs at Wright-Patterson Medical Center near Dayton. Part D is optional because TRICARE drug coverage is creditable.
Keep Part B. If you're eligible for premium-free Part A and drop Part B, you lose TRICARE coverage, except for prescriptions filled at a military pharmacy.
Getting TFL at 65
- Sign up for Part B on time. TRICARE advises enrolling no later than the month before your birth month to avoid a gap.
- Check DEERS. Make sure your record shows your Medicare coverage.
- Tell your providers. Show your Medicare card and military ID so claims go to the right place.
Full details are in our guide to veterans, TRICARE and Medicare in Ohio. If you're considering a Medicare Advantage or Part D plan alongside TFL, you can request a call from a licensed insurance agent.
Related questions
Do I need Part B with TRICARE For Life?
Who must keep Part B, and the exceptions.
What happens to TRICARE Prime at 65?
The switch to TFL, step by step.
Can I use the Wright-Patterson pharmacy?
Military pharmacies with Medicare.
Sources
- TRICARE — TRICARE For Life
- TRICARE — TRICARE For Life Handbook
- TRICARE — Becoming Medicare-eligible
- Medicare.gov — Who pays first?
More questions in this guide
- Can military retirees on Medicare use the Wright-Patterson pharmacy?
- Can veterans in Ohio have Medicare Advantage and VA care?
- Do I need Medicare if I have VA health care in Ohio?
- Do I need Medicare Part B to keep TRICARE For Life?
- What happens to TRICARE Prime when I turn 65?
Part of the guide: Veterans, TRICARE and military retirees in Ohio: how Medicare fits · All questions
Frequently asked questions
Does TFL work with any doctor in Ohio?
TFL follows Medicare. You can see any provider in the U.S. who accepts Medicare. If a provider has opted out of Medicare, Medicare pays nothing and TRICARE pays only what it would have paid as the second payer, so you may owe most of the bill.
Does TFL cover my spouse?
TFL covers each eligible person who has Medicare Part A and Part B. A spouse under 65 keeps their own TRICARE plan until they become eligible for Medicare.
Can I use TFL with a Medicare Advantage plan?
Yes. You keep TFL if you join a Medicare Advantage plan. TRICARE's TFL handbook says TFL can reimburse copayments for TRICARE-covered services when you file a paper claim.
Medicare in your Ohio county
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