Coordination of Benefits & Claims

• Who pays first, Medicare or TRICARE For Life?Medicare pays first for any service it covers. TFL pays second. The claim usually crosses over automatically — you should never pay out of pocket up front.
• Why did I get a bill if I have Medicare and TFL?Usually because the claim didn't cross over, DEERS is out of date, the provider doesn't accept Medicare, or the service isn't covered. Don't pay until you understand which one.
• Do I have to file claims myself?Almost never. Medicare and TFL claims cross over automatically. The exceptions are non-network pharmacy, overseas care, and providers who opt out of Medicare.
• How does the Medicare-to-TFL claim crossover work?Medicare processes the claim, pays its share, and electronically forwards it to WPS using your sponsor SSN. WPS pays TFL's share directly to the provider — usually within 2–3 weeks.
• What is a Medicare Summary Notice (MSN)?A quarterly summary from Medicare listing every claim filed under your number — what Medicare approved, paid, and what you may owe. Compare it against your WPS TFL EOBs.
• What is the WPS TFL EOB and where do I get it?It's WPS's Explanation of Benefits showing how TFL processed each crossover claim. Access it at tricare4u.com or by mail. It's not a bill.
• What if Medicare paid but TFL didn't?Usually a DEERS issue or a crossover failure. Call WPS at 1-866-773-0404 with your Medicare claim number — they can manually process it.
• Should I pay the doctor's office up front?Almost never. Medicare and TFL pay providers directly. If a Medicare-participating provider asks for payment beyond a known small copay, ask them to bill Medicare first.
• How long do I have to file a paper TFL claim?You have one year from the date of service to file a TFL claim with WPS. Three years for overseas claims. File ASAP after Medicare processes its part.
• I have other insurance besides Medicare and TFL. Who pays first?Order varies. Active-employment group insurance pays before Medicare; retiree coverage like FEHB pays after Medicare and usually before TFL. TFL is almost always last.

Educational only — not insurance, legal, or tax advice. Verify with Medicare (1-800-MEDICARE), WPS (1-866-773-0404), SSA, or a licensed advisor before making enrollment decisions.