TFL & HMOs: Your membership in an HMO may make it difficult for you to use
TFL benefits and may make it impossible to use your preferred Medicare
physician. Federal law requires Tricare to be the last payer to all other
coverage with the exception of specially written Tricare supplements and
Medicaid-like programs. That means you must use your Medicare and HMO
coverage before you can use Tricare. HMOs generally require their member
to assign their Medicare benefits to the HMO. After Medicare and the HMO
have provided their benefits, you may file a claim with Tricare for any
out-of-pocket expenses such as your HMO's copayments. By law Tricare
cannot pay your Medicare or HMO premiums.
If you do not have an HMO you can use the Medicare provider of your
choice. Medicare would process the claim, pay its share to the provider
and forward the claim to Tricare. Tricare would pay what Medicare did not,
up to the amount of your legal debt as established by the Medicare/Tricare
laws. In this situation you would have no, or very limited, out-of-pocket
expenses for the vast majority of your health care. [Source: James Hamby
article 18 FEB 02 Navy Times]