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TRICARE for Life and Long Term Senior Care
| Definition |
TRICARE for Life Eligibility Guidelines |
Costs |
| Pros & Cons |
Benefit Types & Limits |
How to Apply |
| Overview of Tricare for Life | ||
Provided by the Department of Defense, TRICARE is a health insurance and care program for active or retired members and family of all seven uniformed services: the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health Service and NOAA. A “retired” member of the military is someone who has 20 years of service. All military retirees are veterans but not all veterans are military retirees. TRICARE for Life (TFL) is an extension of TRICARE for seniors enrolled in Medicare.
TFL serves as the secondary payer to minimize veteran seniors’ out-of-pocket expenses by covering the Medicare's coinsurance and deductible. Care is provided by a network of both military and civilian health professionals.
Much like Medigap insurance, TRICARE for Life (TFL) picks up where Medicare leaves off. TFL will pay the co-insurance and deductibles but does not pay for the monthly Medicare Part B premium.
Assisted Living
TFL does not pay for long term care or custodial care as defined by assistance with activities of daily living such as bathing, dressing, feeding or supervision of the cognitively impaired.
Skilled Nursing
TFL will pay for skilled nursing care to an extent. Like Medicare, there must be a medical condition that was treated in a hospital for 3 consecutive days and the senior must be admitted to a skilled nursing facility within 30 days.
Medicare has a 100 day limit on skilled nursing and TFL will be the primary payer after that 100 day limit, but will not cover the full amount. Co-payment in the amount of $100-$200 / day should be expected.
In-Home Care & Adult Day Care
TFL does not pay for either medical care or supervision in the home or in adult day care situations.
Be Aware That:
-TRICARE for Life is only for military retirees.
-There are other benefits for veterans including the VA Aid & Attendance Benefit and VD-HBCS program (Cash and Counseling for Veterans).
-There are other benefits for veterans including the VA Aid & Attendance Benefit and VD-HBCS program (Cash and Counseling for Veterans).
TRICARE for Life is Also Known As:
-Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
-TFL
-TFL
Age Requirements
Veterans or their family must be 65 to be eligible for TRICARE for Life. There is an exception for younger individuals if they are enrolled in Medicare already as a result of a disability.
Disabilities / Health Requirements
A senior veteran’s disability status, service-connected or otherwise does not affect their eligibility for TRICARE for Life.
Family Status
Family or marital status does not play a role in TRICARE for Life eligibility with the exception of surviving spouses that have re-married who are no longer eligible. Divorce or death of the new spouse does not enable them to re-gain their eligibility.
Financial Status Requirements
Veterans and / or their surviving spouses with any level of financial resources and income are eligible for TRICARE for Life.
Veteran Status Requirements
Veterans cannot have been dishonorably discharged.
Geographic Requirements
Geographic location is not a factor in determining eligibility for TRICARE for Life.
Other Requirements
Medicare Requirement - Veterans or their spouses must be enrolled in Medicare Part A & B to be eligible for TRICARE for Life.
Types of Benefit Payout
Benefits payments are made directly to the medical providers. Veterans at no point receive cash or checks from TRICARE for Life.
Restrictions on How Payout Can be Used
Benefits are only from medical services and are paid directly to the providers.
Benefits Amounts & Limits
Of the relevant long term care options for seniors, TRICARE for Life only pays for limited skilled nursing care. The limits, combined with Medicare are as follows:
Days of Coverage | Medicare | TFL | Individual |
Day 1-20 | 100% | 0% | 0% |
Day 20-100 | 80% | 20% | 0% |
Day 100+ | 0% | 75% | 25% |
Time to Receive Benefits
-If the individual is already a TRICARE beneficiary, then enrollment in TRICARE can be immediate.
-If the individual is not a TRICARE beneficiary, then the processing time can vary from 1-6 months depending on the amount of information that must be confirmed with other federal agencies.
-If the individual is not a TRICARE beneficiary, then the processing time can vary from 1-6 months depending on the amount of information that must be confirmed with other federal agencies.
This Source Can Help For
Limited skilled nursing care.
There are no enrollment fees or monthly premiums for TFL. However, veterans and/or their spouses must purchase Medicare Part B and pay those monthly premiums to be eligible for TFL.
Veterans manage their TRICARE enrollment through the Defense Enrollment Eligibility Reporting System known as DEERS, which can be done on their website.
To enroll in TRICARE for Life, a veteran must confirm that their Medicare Part B status is current in DEERS. Their record will then show they are “eligible for TRICARE For Life.”
