If you join a Medicare Advantage plan with TFL

TFL doesn't disappear — it moves to the back seat

Joining a Medicare Advantage plan replaces how your Part A and B benefits are delivered, not your TRICARE eligibility. TFL becomes secondary to the MA plan, picking up cost-sharing for TRICARE-covered services. Done deliberately — usually for plan extras like dental, vision, hearing, or OTC allowances — it can work. The coordination just gets real, in three specific ways.

01 — Your network now matters

• On a Medicare Advantage plan, stay in network — including on PPO plans
• Going out-of-network, even on a PPO, may mean out-of-pocket costs that TFL won't fully absorb, since TFL pays as secondary based on what the plan allows

That's the philosophical trade: TFL with Original Medicare has no network at all. With MA, the plan's directory becomes your map again.

02 — How claims get paid

• Your provider bills TRICARE through Wisconsin Physicians Service (WPS), secondary to your MA plan
• If a provider can't bill TFL, you pay at the time of service, then submit form DD2642 to WPS for reimbursement
• You have 1 year from the service date to submit

Unlike the automatic Medicare-to-TFL crossover, MA plans don't always forward claims — so some paperwork lands on you. Everything you need is on the claims & contacts page.

03 — What changes for your prescriptions (the big one)

If your MA plan includes drug coverage (an MAPD):

• Your MAPD drug coverage becomes primary
• You lose access to Express Scripts home delivery
• Your pharmacy must bill both the MAPD and Express Scripts
• Use only pharmacies that are in-network for both plans

Keeping both benefits active means coordinating two pharmacy systems. Stay in-network for both, and confirm your medications are covered before you switch pharmacies — a little planning keeps your prescriptions running smoothly. The cleaner alternative for many TFL households considering MA: an MA-only plan (no drug coverage), which leaves Express Scripts as your sole, primary pharmacy benefit untouched. The creditable coverage SEP exists for exactly this move.