When Might You Need to File a Claim?

For most Medicare-covered services received in the United States, you won't need to file your own claim because Medicare generally forwards the claim to the Tricare For Life contractor automatically.

However, there are situations where you may need to submit a claim yourself, including:

• Medicare doesn't automatically forward the claim.

• You're seeking reimbursement for a covered service.

• You have other health insurance that changes how the claim is processed.

• You're enrolled in a Medicare Advantage plan, which generally doesn't automatically cross claims over to Tricare For Life.

• You received care overseas.

If you're unsure whether you need to submit a claim, contact the Tricare For Life contractor before mailing paperwork.

If you're required to file a claim, you'll generally complete DD Form 2642 (Patient's Request for Medical Payment)and submit it with any required supporting documentation. The official How to File Claims with Tricare For Life guidance explains the process and required documentation.

Important: Claims for care received in the United States and U.S. territories generally must be filed within one year of the date of service (or inpatient discharge).

What If I Receive Care Overseas?

Tricare For Life works differently overseas because Medicare generally doesn't provide coverage outside the United States and its territories.

In most overseas situations, you'll file your claim with the TRICARE Overseas Program contractor rather than Medicare. If you paid for your care out of pocket, you may also need to include proof of payment and supporting documentation with your claim.

Because overseas claims can vary depending on where you receive care, review the official TRICARE Overseas Program guidance before submitting your claim.

What If I Have Other Health Insurance?

If you have employer-sponsored insurance or another health insurance plan in addition to Medicare and Tricare For Life, the claims process may be different.

Depending on your situation, Medicare and your other health insurance may process the claim before Tricare For Life. In some cases, you may need to submit a paper claim to the Tricare For Life contractor along with your Medicare Summary Notice (MSN) and your other insurance company's Explanation of Benefits (EOB).

If you have other health insurance, review the official Using Tricare For Life with Other Health Insurance guidance to understand how benefits are coordinated.

What If Medicare Denies My Claim?

A Medicare denial doesn't always mean Tricare For Life will pay. It depends on why Medicare denied the claim.

For example:

• If Medicare denies a service because it isn't a Medicare-covered benefit, Tricare may still consider the claim under its own coverage rules.

• If Medicare denies the claim because required information is missing or the claim wasn't filed correctly, the issue generally needs to be corrected before Tricare For Life can determine benefits.

• If the service isn't covered by either Medicare or Tricare, you may be responsible for the cost.

Before contacting Medicare, Tricare For Life, or your provider, review your Medicare Summary Notice (MSN) or Medicare Advantage Explanation of Benefits (EOB) to understand the reason for the denial.

What If I Receive a Bill?

Don't panic if you receive a bill before paying it.

Sometimes providers send bills before Medicare and Tricare For Life have both finished processing the claim.

Before making a payment:

• Confirm that Medicare has processed the claim.

• Verify that the claim crossed over to the Tricare For Life contractor if applicable.

• Review your Medicare Summary Notice (MSN) or Medicare Advantage Explanation of Benefits (EOB).

• Review your Tricare Explanation of Benefits (EOB).

• Contact your provider's billing office if you have questions.

If something doesn't look right, don't assume you owe the balance until you've confirmed how both Medicare and Tricare For Life processed the claim.

Frequently Asked Questions

Do I usually need to file my own claim?

No. For most Medicare-covered services received in the United States, claims generally cross over automatically from Medicare to the Tricare For Life contractor.

Does this work the same way with Medicare Advantage?

No. Medicare Advantage claims generally don't automatically cross over to Tricare For Life. You may need to submit a paper claim to the Tricare For Life contractor for reimbursement of eligible Tricare-covered cost-sharing.

Can I check the status of my claim?

Yes. Most Tricare For Life beneficiaries can review claim status and Explanation of Benefits (EOBs) through the TRICARE4u portal.

Who is the Tricare For Life contractor?

The Tricare For Life contractor is Wisconsin Physicians Service (WPS) Military and Veterans Health.

⚠️ Educational Disclaimer

The Tricare For Life Care Initiative (TFLCI) is a 501(c)(3) nonprofit organization dedicated to providing educational information to military retirees, families, and beneficiaries. We are not affiliated with or endorsed by the Department of Defense, Defense Health Agency, TRICARE, Medicare, or the Social Security Administration. Always refer to official government sources or contact the appropriate agency regarding your individual benefits and eligibility.