Glossary
Copayment (Copay)
A flat dollar amount you pay for a covered service, such as $20 for a doctor visit.
Also known as: Copay
Quick answer
A copayment is a fixed dollar amount paid at the time of service for a covered benefit. Copays are most common in Medicare Advantage and TRICARE Prime; Original Medicare more often uses coinsurance.
Why it matters
If you join a Medicare Advantage plan, copays — not coinsurance — will dominate your cost-share. TFL is what reimburses those copays on services covered by both.
Why this matters at age 65
On Original Medicare + TFL there are essentially no copays. On MA + TFL, copays appear but TFL pays them as secondary. Either way, the goal is $0 out-of-pocket.
When you'll encounter it
Most often at MA-plan doctor visits, urgent care, specialist visits, and pharmacy.
Impact on Medicare
Original Medicare rarely uses copays — it uses coinsurance and deductibles.
Impact on TRICARE For Life
TFL pays plan copays for dual-covered services after the MA plan adjudicates the claim.
Impact on Medicare Advantage
Copays are the primary cost-sharing mechanism on most MA plans.
Common misconceptions
- "Copays don't count toward my MOOP." — On MA plans, copays for in-network covered services DO count toward the plan's annual MOOP.
- "TFL won't refund my copays." — TFL reimburses MA copays for TRICARE-covered services — file or let WPS process via crossover.
Common mistakes to avoid
- Forgetting to give the provider the TFL card on top of the MA card.
- Not keeping receipts for copays paid at urgent care or specialist offices.
Real-world scenario: On an MA plan, a retiree pays a $45 specialist copay at check-in.
The MA plan files with WPS. TFL reimburses the $45 directly to the patient (or to the provider if billed that way).
What should I do?
- 1Show both your MA card AND TFL card at every visit.
- 2Save every copay receipt and EOB until TFL pays.
- 3If WPS doesn't auto-pay an MA copay, file a paper claim with the MA EOB attached.
Questions people commonly ask
Continue learning
— suggested by the knowledge graph- Understanding Original Medicare (Parts A & B) for veteransExactly what Part A and Part B cover, what they cost in 2026, and why both are required to keep TRICARE For Life.
- Enrolling in Medicare: timing, methods, and the military-specific rulesWhen and how to sign up for Medicare Parts A and B — and the timing that protects your TRICARE For Life activation.
- What is Medicare? A complete overview for retired militaryA plain-English, handbook-grounded overview of the federal health insurance program for people 65 and older, written specifically for retired service members and their families.
- Balance BillingThe practice of a provider billing you for the difference between their charge and what insurance approved.
- Benefit Period (Part A)The Part A timeframe used to measure hospital deductibles and coinsurance — it resets after 60 days out of the hospital.
- Billing ErrorsMistakes — accidental or intentional — on Medicare or TFL claims, ranging from duplicate charges to outright fraud.
- Brand-Name DrugsFDA-approved drugs sold under a manufacturer's proprietary name — middle copay tier on the TRICARE formulary.
- ClaimA formal request to an insurer for payment of a covered service.
- Coordination of Benefits (COB)The federal and contractual rules that determine which insurer pays first when you have more than one health plan.
- What is Extra Help and do I need it on TFL?Extra Help (LIS) lowers Part D drug costs for low-income beneficiaries. TFL beneficiaries usually don't need it because TRICARE Pharmacy is already very low cost — unless you also enroll in a Part D plan.
- Does TFL cover preventive care like flu shots and screenings?Yes. Medicare covers most preventive services at $0 when provided by a Medicare-participating provider, and TFL adds no additional cost.
- How much does Medicare Part B cost?Most people pay the standard Part B premium (roughly $185/month in 2026). Higher-income retirees pay IRMAA on top. Lower-income retirees may qualify for help paying it.
- Is there an enrollment fee for TRICARE For Life?No. TFL has no enrollment fee and no monthly premium. The only premium you pay is for Medicare Part B.
- What does TRICARE For Life actually cover?TFL is a wraparound. For services Medicare and TFL both cover, TFL pays nearly all remaining cost-shares. For Medicare-only services, TFL still acts as secondary. For TFL-only services (very few), TFL pays as primary.
Related glossary terms
Related Official Resources
Continue learning straight from the source. Every link below goes to an official government or DoD resource.
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.