Dual Eligible Beneficiaries/TRICARE For Life
When a beneficiary has both Medicare and TRICARE, the beneficiary is considered dual eligible. His or her TRICARE option is called TRICARE For Life and claims are handled by Wisconsin Physicians Service (WPS) – Military and Veterans Health.
Eligibility guidelines differ due to rules regulating Medicare Part A, Medicare Part B and TRICARE For Life.
For more information visit tricare.mil/medicareeligible.
In most cases, when Medicare serves as the primary payer, providers do not need to get prior authorizations or referrals from Health Net Federal Services, LLC. Visit our Authorizations page to learn more about exceptions. If the beneficiary has exhausted his or her Medicare coverage, or the service is covered by TRICARE but not Medicare, the beneficiary may need a prior authorization or referral from Wisconsin Physicians Service (WPS) – Military and Veterans Health.
In most cases, Medicare serves as primary payer and TRICARE as secondary payer, except when:
- Medicare does not offer coverage or the Medicare benefit has been exhausted, TRICARE will be the only payer and the beneficiary will be responsible for applicable deductibles and cost-shares.
- Medicare offers coverage and TRICARE does not, Medicare serves as the only payer and the beneficiary will be responsible for applicable deductibles and cost-shares.
- Neither Medicare nor TRICARE offer coverage, beneficiaries are responsible for the entire bill.
If the beneficiary has other health insurance (OHI) as well as Medicare and TRICARE, TRICARE will pay after Medicare and the OHI. Once Medicare and the OHI have processed the claim, the beneficiary should file a TRICARE claim with WPS.
Read more about TRICARE and OHI guidelines on our Other Health Insurance page.
Providers should file claims with Medicare first. Medicare will then forward the claim to WPS after Medicare has paid its portion of the claim.
For more information visit WPS’s website or the Defense Health Agency's TRICARE For Life page.
