TRICARE For Life Cost Estimator

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• Primary care visit

  Civilian Medicare-participating doctor

  A routine office visit with a doctor who accepts Medicare assignment. Medicare pays 80% of the approved amount; TFL covers the remaining 20% coinsurance.

  Allowed

  $120

  Medicare pays

  $96

  TFL pays

  $24

  You pay

  $0

  TFL Handbook 2026, §4 — How TFL pays for Medicare-covered services

• Specialist visit

  Civilian Medicare-participating specialist

  A specialist consultation (cardiology, orthopedics, dermatology, etc.). Same 80/20 split applies; TFL absorbs the coinsurance.

  Allowed

  $250

  Medicare pays

  $200

  TFL pays

  $50

  You pay

  $0

  TFL Handbook 2026, §4

• Emergency room visit

  Hospital ER (covered by both)

  ER visit for a non-admission emergency. Medicare Part B covers the facility and physician charges; TFL covers the cost-share.

  Allowed

  $1,800

  Medicare pays

  $1,440

  TFL pays

  $360

  You pay

  $0

  TFL Handbook 2026, §4; CMS Part B coinsurance schedule

• Inpatient hospital stay (5 days)

  Medicare-participating hospital, Part A

  A 5-day inpatient admission. Medicare Part A covers the stay after the inpatient deductible ($1,676 in 2025; check current year). TFL pays the Part A deductible.

  Allowed

  $18,000

  Medicare pays

  $16,324

  TFL pays

  $1,676

  You pay

  $0

  TFL Handbook 2026, §4; CMS Part A deductible (2025)

• Diagnostic imaging (MRI)

  Outpatient imaging center

  Outpatient MRI ordered by your physician. Medicare Part B covers 80% of the approved amount; TFL covers the 20% coinsurance.

  Allowed

  $1,200

  Medicare pays

  $960

  TFL pays

  $240

  You pay

  $0

  TFL Handbook 2026, §4

• Urgent care visit

  Medicare-participating urgent care

  Walk-in care for a non-emergency illness or minor injury. Medicare Part B covers 80%; TFL covers the rest.

  Allowed

  $200

  Medicare pays

  $160

  TFL pays

  $40

  You pay

  $0

  TFL Handbook 2026, §4

• Skilled nursing facility (20 days)

  Medicare-certified SNF after qualifying hospital stay

  Days 1-20 are fully covered by Medicare. Days 21-100 carry a daily Medicare coinsurance — TFL pays that coinsurance.

  Allowed

  $4,000

  Medicare pays

  $4,000

  TFL pays

  $0

  You pay

  $0

  Days 21-100 carry a Medicare daily coinsurance (~$209.50 in 2025) that TFL covers. After day 100, neither Medicare nor TFL pays for SNF custodial care.

  TFL Handbook 2026, §4; CMS SNF benefit schedule

• TRICARE-covered service NOT covered by Medicare

  e.g. care received overseas

  When TRICARE covers a service but Medicare does not (such as most overseas care), TFL becomes the primary payer and applies the standard TRICARE cost-share and deductible.

  Allowed

  $500

  Medicare pays

  $0

  TFL pays

  $375

  You pay

  $125

  Overseas, you typically pay providers up front and file a TRICARE claim for reimbursement. The TRICARE annual deductible and 25% cost-share apply.

  TFL Handbook 2026, §5 — Overseas care

• Medicare-covered service NOT covered by TRICARE

  e.g. chiropractic spinal manipulation

  If Medicare covers a service that TRICARE doesn't, Medicare pays its 80% and you owe the 20% coinsurance — TFL does not fill the gap.

  Allowed

  $80

  Medicare pays

  $64

  TFL pays

  $0

  You pay

  $16

  TFL Handbook 2026, §4