Lesson 4 of 15
How Medicare and TFL work together
Quick answer
Medicare pays first as the primary payer. TFL pays second and picks up most of the remaining Medicare cost-share (deductibles and coinsurance) for services covered by both programs. Most retirees pay $0 out of pocket at participating providers.
Key takeaways
- Medicare = primary payer. TFL = secondary payer.
- Claims usually crossover automatically from Medicare to WPS.
- Show both your red-white-and-blue Medicare card and your Uniformed Services ID at the provider.
- $0 typical out-of-pocket for services covered by both programs at participating providers.
Detailed explanation
Coordination of benefits is the rulebook for who pays first when you have more than one source of health coverage. For retired military with Medicare + TFL, the rules are simple and favorable.
Step-by-step claim flow
- You receive care from a Medicare-participating provider.
- The provider bills Medicare.
- Medicare pays its share (typically 80% of the approved amount for Part B services).
- Medicare automatically forwards the claim to WPS (the TFL claims processor).
- WPS pays the remaining Medicare cost-share.
- You receive an Explanation of Benefits from both. Typical balance due: $0.
When you might owe something
- Provider doesn't accept Medicare. A provider who has fully opted out of Medicare bills you directly; TFL can pay only a limited amount and you may owe more.
- Service is covered by Medicare but not TFL. You owe the Medicare 20% coinsurance.
- Service is covered by TFL but not Medicare. Standard TRICARE Select deductible and cost-shares apply.
- Service is covered by neither. You owe the full amount.
Practical tips
- Confirm the provider accepts Medicare assignment, not just "Medicare patients."
- Keep DEERS up to date so claims process cleanly.
- If a claim does not crossover automatically, you can file with WPS directly.
Frequently asked questions
Do I need to file claims myself?
Almost never. Medicare-participating providers bill Medicare, and Medicare auto-forwards to WPS. You typically just confirm the EOBs.
What if a provider says they don't take TFL?
TFL has no network. If they accept Medicare, they effectively accept TFL as the secondary payer through the WPS claims process.
Official government resources
Official Medicare and TRICARE publications are the definitive source. This page is an independent educational summary; always confirm specifics against the resources above.