How TFL and Medicare split the bill
TRICARE describes TFL as Medicare-wraparound coverage. With Original Medicare, your doctor or hospital bills Medicare, Medicare pays its share, and Medicare sends the claim on to TRICARE's TFL claims processor. You don't enroll in TFL or pay an enrollment fee, but you pay the Part B premium ($202.90 a month for most people in 2026).
| Your situation | Who pays first |
|---|---|
| Retired, with Medicare and TFL | Medicare, then TRICARE |
| You or your spouse still work and have employer coverage | Employer plan, then Medicare, then TRICARE |
| A service TRICARE covers but Medicare doesn't | TRICARE; you pay its deductible and cost shares |
| Care at a military hospital or clinic | TRICARE |
TRICARE's handbook says TFL covers the Part B deductible for services both programs cover, and TRICARE pays the excess charge (up to 15% above the Medicare-approved amount) that a non-participating Medicare provider may bill.
What it means in North Carolina
- Any Medicare provider. TFL adds no network. Hospitals and doctors from the mountains to the coast that accept Medicare work with TFL, and so do providers in other states when you travel.
- Military hospitals and clinics. You can use Womack Army Medical Center at Fort Bragg, Naval Medical Center Camp Lejeune or a base clinic only if space is available. TRICARE says TFL beneficiaries will likely need civilian Medicare providers.
- VA care is different. VA providers can't bill Medicare. For VA care not related to your service, TRICARE pays at most 20% of its allowable amount, so you could owe up to 80%.
- Prescriptions. TRICARE pharmacy coverage continues, including military pharmacies. TRICARE says you don't need Part D.
- State Health Plan retirees. The State Health Plan says TFL members may enroll in its group Medicare Advantage plans and that TFL typically covers copays and coinsurance.
Keep Part B. If you're eligible for premium-free Part A and drop Part B, you lose TRICARE coverage, except prescriptions filled at a military pharmacy.
Getting TFL at 65
- Sign up for Part B on time. TRICARE says to enroll no later than one month before your birth month (if your birthday isn't on the first) to avoid a gap.
- Check DEERS. Make sure your record shows your Medicare coverage.
- Show both cards. Give providers your Medicare card and your uniformed services ID so claims go to the right place.
Full details are in our guide to military retirees, veterans and TRICARE in North Carolina. If you're considering a Medicare Advantage or Part D plan alongside TFL, you can request a call from a licensed insurance agent.
Related questions
Do I need Part B with TRICARE For Life?
Who must keep it, and the exceptions.
What happens to TRICARE Prime at 65?
The switch to TFL, step by step.
Can retirees use the Fort Bragg pharmacy?
Military pharmacies with Medicare.
Sources
- TRICARE — TRICARE For Life
- TRICARE — TRICARE For Life Handbook (updated August 2026)
- Medicare.gov — Who pays first? (TRICARE)
- State Health Plan for Teachers and State Employees
More questions in this guide
- Can military retirees on Medicare use the Fort Bragg pharmacy?
- Can veterans have Medicare Advantage and VA care in North Carolina?
- Do I need Medicare if I have VA health care in North Carolina?
- Do I need Medicare Part B with TRICARE For Life?
- Does Medicare cover illnesses from Camp Lejeune water contamination?
- What happens to TRICARE Prime at 65 in North Carolina?
Part of the guide: Military retirees, veterans and TRICARE in North Carolina: how Medicare fits · All questions
Frequently asked questions
Does TFL work with any doctor in North Carolina?
TFL follows Medicare, so you can see any provider who accepts Medicare. If a provider has opted out of Medicare, Medicare pays nothing and TRICARE pays only what it would have paid as second payer, so you may owe most of the bill.
Can I use TFL with a Medicare Advantage plan?
Yes. TRICARE's TFL handbook says you must use the plan's network except for emergencies, and that TFL can reimburse copayments for TRICARE-covered services when you file a paper claim.
Does TFL cover my spouse?
TFL covers each eligible person who has Medicare Part A and Part B. A spouse under 65 keeps their own TRICARE plan until they become eligible for Medicare.
Medicare in your North Carolina county
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