Dependents and Tricare for Life: What Families Need to Know
When a retiree moves into Tricare for Life, dependent children don’t automatically follow. Instead, they remain on Tricare Prime or Select until age 21 (or 23 if in college), then may choose Tricare Young Adult until 26. In some cases, children may qualify for Medicare early, in which case their coverage shifts into TFL. Here’s what families need to know to prepare.
When a military retiree turns 65 and moves into Tricare for Life (TFL) with Medicare Parts A & B, the rest of the family often wonders: “What happens to us?” Spouses and children don’t automatically move into TFL just because the retiree does. Instead, dependents each follow their own eligibility rules. This guide walks through what happens step by step.
When the Retiree Moves Into TFL
Retiree at 65: Must enroll in Medicare Part A and Part B. Once active, coverage automatically becomes Tricare for Life. Medicare pays first, TFL pays second.
Spouse under 65: Remains on Tricare Prime or Select until their own 65th birthday. At that time, they must also enroll in Medicare Parts A & B to shift into TFL.
Children: Remain covered under Tricare Prime or Select as long as they are age-eligible.
📎 TRICARE FAQ – Spouse Younger than Sponsor at 65
Age-Out Rules for Children
Children don’t move into TFL just because the retiree does. Instead, they age out of standard Tricare coverage:
Standard Rule: Coverage until age 21.
If in College: Coverage until age 23, provided they are enrolled full-time and the retiree provides at least 50% support.
After Age-Out: Regular Tricare Prime/Select coverage ends.
📎 Tricare – Eligibility for Children
What Happens Next: Tricare Young Adult (TYA)
After age-out, children may purchase Tricare Young Adult (TYA), which extends coverage until age 26.
Eligibility: Unmarried, under 26, not eligible for employer-sponsored insurance.
Plan Options:
TYA Prime – Like Tricare Prime (where available).
TYA Select – Like Tricare Select, available worldwide.
Costs: Monthly premiums paid by the young adult, plus standard cost-shares.
Special Circumstances: When Dependents Qualify for Medicare
While most children and spouses don’t enter TFL until they turn 65, there are exceptions:
Disability: After 24 months of SSDI, dependents may qualify for Medicare.
End-Stage Renal Disease (ESRD): Medicare eligibility at any age with permanent kidney failure.
ALS (Lou Gehrig’s disease): Medicare eligibility begins the same month SSDI starts.
In these cases:
The dependent must enroll in Medicare Part A and Part B.
Their Tricare coverage will shift to TFL, regardless of age.
Premiums and Costs to Expect
Children on Tricare Prime or Select
They remain covered under the family’s single or family-rate premium, depending on whether both spouse + children are enrolled.
The retiree’s shift to TFL does not remove the need to pay these premiums for younger children.
Children on Tricare Young Adult (TYA)
Once a child ages out (21, or 23 if a student), they may buy TYA.
TYA has its own monthly premium, separate from family coverage.
Costs are set annually and depend on whether the child enrolls in TYA Prime or TYA Select.
Children Who Qualify for Medicare (Special Cases)
If a child becomes Medicare-eligible due to disability, ESRD, or ALS, they must enroll in Medicare Parts A & B.
At that point, they transition to TFL, and their main cost becomes the Medicare Part B premium.
Key Takeaways
TFL is individual-based. Spouses and children don’t move into TFL until they become Medicare-eligible themselves.
Children age out of regular Tricare at 21 (or 23 in college).
TYA extends coverage until age 26 for those who qualify.
Special circumstances (disability, ESRD, ALS) can make dependents Medicare-eligible earlier, in which case they shift to TFL.
Families should plan ahead for both age-based transitions and special medical situations to avoid gaps in coverage.
Bottom Line: When the retiree moves into Tricare for Life, dependents don’t automatically follow. Spouses stay on Prime/Select until their own 65th birthday, children remain covered until they age out, and then TYA may bridge coverage until 26. In rare cases, dependents with disabilities or certain health conditions may qualify for Medicare early, which allows them to move into TFL.
Retiree Turns 65 but Spouse or Children Are Younger: What Happens with Tricare for Life?
When a military retiree turns 65, they transition into Tricare for Life with Medicare A & B, but what happens to younger spouses and children? This guide explains how family coverage continues, how premiums are affected, and what you need to know to avoid surprises during this transition.
One of the most common points of confusion is what happens when a military retiree reaches age 65 but their spouse or dependent children are still younger. Does the whole family switch to Tricare for Life (TFL)? The short answer: no. Each family member transitions based on their own eligibility.
What Happens When the Retiree Turns 65?
At 65, the retiree must enroll in Medicare Part A and Part B.
Once both parts are active and DEERS is updated, the retiree’s Tricare coverage automatically becomes Tricare for Life.
Medicare becomes the primary payer, and TFL becomes the secondary payer, filling most of the remaining costs.
What Happens to the Younger Spouse?
If the spouse is under 65, they remain on Tricare Prime or Tricare Select.
Their coverage does not end or change just because the retiree moves into TFL.
When the spouse turns 65, they must also enroll in Medicare Part A and Part B. At that point, they will transition into Tricare for Life.
What Happens to Dependent Children?
Children continue their coverage under Tricare Prime or Tricare Select.
They stay eligible until they age out (21, or 23 if a full-time student).
After aging out, they may purchase Tricare Young Adult if desired.
How Premiums Work in This Scenario
Here’s where families often get confused:
No Premiums for the Retiree on TFL - Once in TFL, the retiree no longer pays Tricare Prime/Select enrollment fees. Their cost is just their Medicare Part B premium.
Family Premiums Continue for Spouse/Children -The spouse and children who remain on Tricare Prime or Select must still pay premiums (you can read more on this here):
If only the spouse is covered → single-rate premium.
If the spouse and children are covered → family-rate premium.
No Double Billing - You won’t be charged both a retiree premium and a family premium. The premium is only based on who is still enrolled in Prime or Select.
Real-Life Examples:
Case 1: Retiree 65, spouse 62, no children at home
Retiree → Moves into TFL, pays Medicare Part B.
Spouse → Remains on Tricare Prime at the single-rate premium until age 65, then transitions into TFL with Medicare Parts A & B.
Case 2: Retiree 65, spouse 60, two kids (ages 14 and 17)
Retiree → Covered under TFL, no Tricare premium.
Spouse + children → Covered under Tricare Prime at the family-rate premium until kids age out (or until spouse reaches 65).
Key Takeaways
The retiree moves into TFL at 65 with Medicare A & B.
Spouse and children stay on Tricare Prime/Select until they reach their own eligibility milestones.
Premiums adjust based on who remains on Tricare Prime/Select (single or family rate).
No one loses coverage, it simply looks different for each family member depending on age and eligibility.
Bottom Line: When the retiree turns 65, they move into Tricare for Life. Younger spouses and children remain on Tricare Prime or Select, and their premiums continue based on single or family coverage. Families should plan for this “split coverage” period so there are no surprises.
Tricare Coverage When the Spouse Turns 65 but Isn’t Eligible for Premium-Free Part A
If a spouse turns 65 before the retiree is 62, coverage doesn’t stop, but it looks different for a few years. At 65, the spouse must enroll in Part B and Tricare Prime or Select will act as secondary coverage. Then, when the retiree turns 62, the spouse becomes eligible for premium-free Part A and transitions into Tricare for Life, with Medicare as primary and TFL as secondary.
For most families, turning 65 means enrolling in Medicare Part A and Part B and moving into Tricare for Life (TFL). But sometimes things don’t line up that neatly. If the spouse reaches 65 but doesn’t yet qualify for premium-free Part A—and the retired service member (sponsor) is younger than 62—you may be left wondering: what happens to my coverage?
You’re not alone. This situation is more common than you might think, and the good news is that there’s a clear path to follow so you stay covered every step of the way.
Why This Situation Happens?
To qualify for premium-free Part A, a person must have at least 40 quarters of Social Security work credits (here’s how work credits are earned). A non-working spouse can use the sponsor’s work record to qualify, but only once the sponsor is at least 62, because that’s the earliest Social Security will let a spouse “draw” on a partner’s credits.
So if the spouse turns 65 before the sponsor reaches 62, Medicare won’t grant them premium-free Part A yet.
Could You Still Get Part A at 65?
Yes, but it would mean buying Part A until your sponsor turns 62.
In 2025, Part A costs up to $505/month if you have fewer than 30 quarters, or $278/month with 30–39 quarters.
Paying for Part A would allow you to move into TFL right away.
But for most families, the cost is too steep, so they wait for premium-free eligibility.
What to Do at 65?
Here’s the important part: you still need to enroll in Medicare Part B when you turn 65, even if you don’t have Part A yet. That way:
You avoid lifetime late penalties for Part B.
You keep your Tricare coverage active.
Next, take your Notice of Award or Disapproved Claim from Social Security to DEERS. This step updates your record and ensures you remain covered under Tricare Prime or Select until your sponsor turns 62.
What Happens When the Sponsor Turns 62?
As soon as your sponsor is 62, things fall into place:
You can apply for premium-free Medicare Part A under your sponsor’s record.
Once Part A is active (and since you’re already enrolled in Part B), you’ll automatically shift into Tricare for Life.
This is the point where your Medicare and Tricare coverage come together, and you move fully into TFL.
A Real-Life Timeline Example:
When the spouse turns 65 (sponsor is still younger than 62): The spouse enrolls in Medicare Part B. For covered services, Medicare Part B pays first and Tricare Prime or Select pays second. The spouse must also take their Social Security Notice of Award or Disapproved Claim to DEERS to keep Tricare Prime/Select active.
When the sponsor turns 62: The spouse becomes eligible for premium-free Medicare Part A based on the sponsor’s work record. With both Part A and Part B in place, the spouse automatically transitions onto TFL, where Medicare (A and B) is the primary payer and TFL pays secondary.
Official Guidance
Tricare addresses this exact scenario here: When You’re Not Eligible for Medicare Part A.
Closing Thoughts
If you’re in this situation, it can feel like one more curveball after a lifetime of navigating military healthcare. But take heart: you’re not falling through the cracks, and you won’t lose your Tricare coverage. There’s just a temporary in-between step before TFL begins.
At TFLCI, we’re here to walk with you through those in-between seasons and help you prepare for the next stage. You’ve carried the load of service, now let us help carry some of the weight of figuring out the benefits you’ve earned.
Surprised by Higher Medicare Premiums? Understanding IRMAA and Your Options
Many retirees are surprised when their Medicare premiums are higher than expected. This extra cost, called IRMAA (Income-Related Monthly Adjustment Amount), affects Medicare Part B and Part D if your income is above certain thresholds. In this post, we’ll explain what IRMAA is, why it exists, how it impacts Tricare for Life, and what steps you can take to plan ahead or appeal if your income has changed.
Many retirees are surprised when their Medicare premiums are higher than expected. You planned for your Medicare Part B premium ($185/month in 2025, projected $206.50/month in 2026), but then an extra charge shows up on your bill. That extra cost is called IRMAA, and it can feel like a nasty surprise.
The good news? Once you understand IRMAA, you’ll know why it happens, how it affects Tricare for Life (TFL), and what you can do about it.
What is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It’s an additional charge added to your Medicare Part B (and sometimes Part D) premiums if your income is above a certain level.
Instead of everyone paying the same “standard” Part B premium, higher-income beneficiaries pay more. These surcharges go directly to Medicare, not Tricare, and TFL does not cover them.
How is IRMAA Calculated?
The Social Security Administration (SSA) determines whether you owe IRMAA based on your Modified Adjusted Gross Income (MAGI) from your IRS tax return two years ago.
Your 2023 income determines your 2025 IRMAA.
Your 2024 income will determine your 2026 IRMAA.
If your MAGI is above certain thresholds, IRMAA applies. The higher your income bracket, the higher your premium.
Why Does IRMAA Exist?
Medicare is heavily subsidized by federal tax dollars. On average, most beneficiaries only pay about 25% of the actual cost of their Part B coverage, while the government covers the rest.
In 2003, Congress decided that higher-income beneficiaries should pay a larger share to help sustain Medicare’s funding. That’s why IRMAA was created.
If your income is above certain thresholds, you pay more than the standard premium. The higher your income, the larger your share of the program’s cost.
IRMAA Brackets for 2025
Individuals: IRMAA begins if your MAGI is above $103,000.
Married couples filing jointly: IRMAA begins if your MAGI is above $206,000.
The surcharge increases in steps as your income rises, sometimes more than doubling your monthly premium.
For the most up-to-date thresholds, see Social Security’s official IRMAA brackets.
(We’ll update these numbers as CMS finalizes 2026 premiums in October.)
How Does IRMAA Affect Tricare for Life?
TFL is designed to wrap around Medicare’s deductibles, coinsurance, and copays. It does not pay for premiums, including IRMAA.
This means:
You pay your Medicare Part B premium.
If IRMAA applies, you pay that surcharge directly to Medicare.
Once those are paid, TFL works as your secondary payer, picking up your Medicare cost-shares for covered services.
Can You Appeal IRMAA? (Yes—and here’s how)
If you’ve experienced a qualified life-changing event that reduced your income—like retirement, work reduction, loss of spouse, divorce, or loss of pension—you can request a reduction or waiver of IRMAA by submitting Form SSA-44 to the Social Security Administration. This form allows SSA to reconsider your Medicare surcharges using more recent income data.
You’ll need to:
Download the form from SSA: SSA-44: Request for Life-Changing Event IRMAA review
Check off the qualifying event and include the event date (month/year).
Provide income info: For the affected year, include your AGI (from IRS Form 1040 Line 11) and tax-exempt interest (Line 2a).
Attach documentation supporting both the life event (e.g., retirement letter, divorce filing, death certificate) and your income (signed tax return or IRS transcript).
Submit the form by mailing or dropping it off at your local SSA office — or upload it online via SSA's portal.
Wait for SSA’s decision, and continue paying IRMAA until you hear back to avoid coverage gaps or penalties.
Important note: SSA only considers the specific events listed on the form. If your income change doesn’t match one, appeals are less likely to be approved.
Appealing a Decision Online
If you disagree with SSA’s decision about your IRMAA, you can file an appeal online through Social Security’s secure portal: File an IRMAA appeal online.
You may also:
File a written Request for Reconsideration (Form SSA-561-U2)
Or contact your local Social Security office for assistance.
📞 Social Security: 1-800-772-1213 (TTY 1-800-325-0778)
Note: If your income went down due to a life-changing event (like retirement or loss of pension), use Form SSA-44 instead of filing an appeal.
Tips for Managing IRMAA
Plan ahead for taxes: Withdrawals from IRAs or large capital gains can raise your income and trigger IRMAA. Work with a financial advisor to time withdrawals strategically.
Watch for one-time income events: Selling property, cashing in investments, or large distributions can push you into IRMAA brackets for two years. Consider the timing.
Appeal if your income drops: If you retire, lose a pension, or experience another qualifying event, file Form SSA-44 to request a reduction.
Closing Thoughts
IRMAA can be frustrating, especially when it catches you off guard. But knowing how it works can help you plan ahead, and in many cases, you can reduce or avoid it with smart financial decisions.
Want to better understand how IRMAA, Medicare, and Tricare for Life fit together? TFLCI is here to help you navigate the process and prepare for what’s ahead.
When Tricare for Life Doesn’t Go Smoothly: How to Fix Common Problems
Tricare for Life not working right? Here’s how to fix the most common issues—fast.
For most retirees, Tricare for Life (TFL) activates seamlessly once you have Medicare Parts A and B and your DEERS record is current. Medicare pays first, TFL pays second, and your bills are usually fully covered.
But sometimes, things don’t go as planned. Maybe your coverage doesn’t show up right away. Maybe a claim bounces back. Or maybe your provider isn’t sure how to bill both Medicare and TFL.
Don’t panic, these issues are common, and most are fixable. Here’s what to do if your TFL isn’t working the way it should.
Step 1: Double-Check Your DEERS Record
Your Defense Enrollment Eligibility Reporting System (DEERS) record must be accurate, or TFL won’t activate properly.
Make sure your address, name, and Medicare Part A & B information are up to date.
Common hiccups include name mismatches (e.g., maiden vs. married name) or outdated addresses.
How to fix: Call 1-800-538-9552 or visit the nearest RAPIDS ID Card office.
Step 2: Confirm Medicare Enrollment
TFL only works if you’re enrolled in both Medicare Part A and Part B.
Look at your Medicare card or log into your my Social Security account to confirm your Part A and Part B enrollment dates. You can also use your Medicare.gov account to review claims and coverage details.
If you delayed enrolling in Part B, TFL won’t start until your Part B begins.
Step 3: Know Who Pays First
In the U.S.: Medicare pays first, then TFL.
Overseas: Medicare doesn’t cover care abroad (except very rare emergencies), so TFL becomes the primary payer.
A lot of denied claims are simply billing errors where providers sent the bill to the wrong payer first.
Step 4: Call Wisconsin Physicians Service (WPS)
WPS is the contractor that processes TFL claims. If your provider billed correctly but your claim is still stuck, call:
📞 WPS TFL Customer Service: 1-866-773-0404
Have your Medicare number, sponsor SSN, and claim information ready when you call.
Step 5: Watch for These Common Hiccups
Medicare Advantage Plans: Claims don’t always flow automatically. Some people need to file manually with TFL. Others report theirs processed without issue.
System Delays: Sometimes it takes weeks for DEERS and Medicare updates to sync.
Coding Errors: If your provider doesn’t bill properly, neither Medicare nor Tricare can coordinate.
Step 6: When to Ask for Help
If you’ve already checked DEERS and Medicare and WPS can’t resolve the issue, don’t go it alone.
Reach out to your local TRICARE office.
Contact TFLCI, we walk members through these exact problems every day and can point you in the right direction.
Closing Thoughts
Tricare for Life is one of the most valuable benefits you’ve earned. While system hiccups can feel stressful, they’re usually resolved with a few phone calls and record updates.
New to TFL? Start with our Beginner’s Guide to Tricare for Life.
Already in the weeds? TFLCI is here to help, reach out to us anytime!
Tricare for Life: A Beginner’s Guide
New to Tricare for Life? This guide breaks down the basics in plain language—what TFL is, who’s eligible, how it works with Medicare, and what you might still pay out-of-pocket. Whether you’re approaching age 65 or supporting a retiree, this post will help you feel confident about your healthcare coverage.
If you’re a military retiree or the spouse of one and nearing age 65, you’ve probably heard the term Tricare for Life (TFL) tossed around. But what exactly is it? How does it work? And what do you need to do to get it?
In this post, we’ll break down the essentials so you can understand your benefits and make confident decisions about your health coverage.
What Is Tricare for Life?
Tricare for Life is a health insurance program for uniformed services retirees and their eligible spouses or dependents who are entitled to Medicare Part A and enrolled in Medicare Part B.
It acts as a “wraparound” plan to Medicare, meaning:
Medicare pays first, covering what it normally would.
Tricare for Life pays second, often covering the remaining costs (like copayments, coinsurance, and deductibles).
In most cases, this means you pay very little or nothing out-of-pocket when you receive medical care from providers who accept Medicare.
Who Is Eligible for Tricare for Life?
To qualify, you must:
Be a uniformed services retiree (this includes the Army, Navy, Air Force, Marine Corps, Space Force, Coast Guard, Public Health Service (USPHS) Commissioned Corps, and NOAA Commissioned Officer Corps).
Be entitled to Medicare Part A and enrolled in Part B.
Be listed in the Defense Enrollment Eligibility Reporting System (DEERS).
TFL is only for members of the uniformed services and their eligible family members. This includes military retirees, NOAA Corps retirees, USPHS retirees, and Medal of Honor recipients.
Note for federal civilian retirees: If you retired under FERS, CSRS, the Postal Service, or another federal civilian agency but never served in the uniformed services, you are not eligible for TFL. Your coverage comes through the Federal Employees Health Benefits (FEHB) program, which coordinates with Medicare at age 65.
You don’t need to enroll in Tricare for Life separately, it automatically activates once you meet the criteria above. However, it’s important to understand that TFL is designed to work with Original Medicare, not Medicare Advantage (Part C) plans.
If you enroll in a Medicare Advantage plan, claims generally don’t transfer automatically to TFL the way they do with Original Medicare. According to Tricare’s official guidance, you’ll likely need to file claims manually for reimbursement of TRICARE-covered services. That said, experiences vary, some beneficiaries report that claims have transferred successfully without needing to file themselves, while others have faced processing delays or denials.
For the most seamless coordination and fewest administrative headaches, TFL works best when paired with Original Medicare.
What Does Tricare for Life Cost?
One of the greatest advantages of Tricare for Life (TFL) is how much it minimizes out-of-pocket expenses. Here's a breakdown of what you'll pay:
No premium for TFL itself.
You must be enrolled in Medicare Part B, which costs $185.00 per month in 2025 (higher-income beneficiaries may pay more based on their income).
Looking ahead: The standard Part B premium is projected to rise to about $206.50/month in 2026, with the official amount announced in October 2025.
You don't pay Medicare Part A or Part B deductibles, as TFL generally covers them after Medicare.
For a detailed breakdown of costs and coverage, you can refer to the Tricare for Life Cost Matrix.
Deductibles and Copays:
With Original Medicare alone, you’d normally pay the Part A deductible ($1,676 in 2025) and the Part B deductible ($257 in 2025), plus coinsurance.
The good news is that Tricare for Life usually picks these up, so for most covered services, you’ll pay little to nothing out-of-pocket when you see a Medicare provider.
What You Might Still Pay For:
For most people, TFL covers what Medicare leaves behind. The times you might owe something are when Medicare doesn’t cover the service, or if you use a provider who isn’t covered by Medicare.
Overseas care: Medicare doesn’t cover care outside the U.S. (except for very limited, rare emergencies), so TFL becomes your primary payer overseas. You may owe the Tricare annual deductible ($150 individual / $300 family) and a cost-share (typically 20–25%). You must use a Tricare-authorized provider. Learn more about using Tricare for Life Overseas.
Using a provider who doesn’t accept Medicare (in the U.S.) but is Tricare-authorized: Medicare pays nothing; TFL is primary. Tricare deductible and cost-share apply.
Using a provider who is neither Medicare- nor Tricare-authorized: Not covered by either program; you’re responsible for the full bill.
Services not covered by Medicare or Tricare: e.g., routine dental, routine vision/eyeglasses for adults, hearing aids, and some alternative therapies, these are typically out-of-pocket. However, you can enroll separately in the Federal Employees Dental and Vision Insurance Program (FEDVIP) for dental and vision coverage. Learn more and enroll here.
Prescriptions: Copays apply for most prescriptions. They are lowest through Express Scripts Home Delivery and $0 at military pharmacies, but higher at retail pharmacies.
VA care (important distinction): Care received at VA facilities is billed under VA benefits; Medicare and TFL don’t pay VA claims. TFL coordination with VA is limited and uncommon.
Summary: When You Do and Don’t Pay
To make it easy, here’s a quick overview of when you might owe money, depending on whether Medicare and/or Tricare covers the service.
Common Questions
Do federal civilian retirees get Tricare for Life?
No. TFL is only available to retirees of the uniformed services (Army, Navy, Air Force, Marine Corps, Space Force, Coast Guard, USPHS, and NOAA) and their eligible family members. Federal civilian retirees (FERS, CSRS, Postal, etc.) use the FEHB program, which coordinates with Medicare separately.
Is Tricare for Life automatic at 65?
Yes, once you have Medicare Part A and B and are listed in DEERS, TFL activates automatically. There’s no separate enrollment process.
Can I use Tricare for Life with a Medicare Advantage plan?
Yes, but claims don’t transfer as smoothly as they do with Original Medicare. You may need to file some claims manually, which can lead to delays. That said, some beneficiaries have reported that their claims processed automatically even with Advantage plans, while others experienced delays or denials.
What if something goes wrong with my TFL activation or claims?
Sometimes hiccups occur when Medicare and TRICARE systems update. If your coverage doesn’t appear active right away or a claim is denied unexpectedly, it’s usually fixable. Check DEERS and Medicare first, then call WPS if needed. TFLCI is always here to guide you through the process.
Still have questions? Every retiree’s situation is a little different. At TFLCI, we’re here to walk alongside you through Medicare, Tricare for Life, and every stage of your healthcare journey. Reach out to us any time through our contact us link—we’re here to help!