Editor’s Note: This article is part of MOAA’s 2021-22 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2021 issue of Military Officer magazine.

October 2021 marked the 20th anniversary of TRICARE For Life (TFL), one of the largest expansions of the military health care benefit and a huge win for MOAA and other military advocates who worked tirelessly to secure a robust health care benefit for Medicare-eligible military retirees.

While the 20th anniversary provides an opportunity to reflect on the TFL victory and the advocacy efforts that drove it, we are also reminded of the importance of protecting the benefit for current Medicare-eligible retirees as well as future generations of TFL enrollees, all of whom sacrificed greatly in support of our nation.

TFL has been under threat for years — both for those who currently rely on the benefit and for our newest generation of military retirees, even after years of war have highlighted the risks and sacrifices associated with career military service. Here is a look at how TFL came to be, why it is more important now than ever, and what lies ahead to protect it.

Meeting a Need

The uniform military health care benefit was created by the Dependents Medical Care Act of 1956, which defined access to military treatment facility (MTF) care in statute. It granted space-available access to MTF care for active duty family members, retirees and their families, and survivors. From 1956 to 2001, the only military health care benefit for retirees aged 65 and older was space-available MTF care and prescription drugs from MTF pharmacies, both at zero out-of-pocket cost.

The post-Cold War drawdown led to the downsizing or closure of many installations and military hospitals. Retirees in these areas lost MTF access and, therefore, their only military health care benefit.

Throughout the 1990s, MOAA and other advocacy groups fought for legislation to improve the health care benefit for Medicare-eligible retirees. Some organizations and individuals turned to the courts claiming breach of contract and said DoD and the services had promised career servicemembers free health care for life. This perception was reinforced by decades of readily available free MTF care.

Federal courts have held there is no legal basis for the claim to free health care for life since it is not supported by statute and regulations and does not grant a right to MTF care, or other free medical care, for retirees and their dependents. However, an appellate court acknowledged the validity of retiree claims and urged Congress to fulfill its moral obligation to retirees.

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MOAA and the TFL Win

MOAA and other military advocacy groups achieved a long-standing goal when Congress addressed military retiree access to care by establishing TFL in the FY 2001 National Defense Authorization Act (NDAA).

TFL provides wraparound coverage that pays out-of-pocket costs after Medicare reimbursement for Medicare-covered services. TFL beneficiaries are also eligible for all TRICARE benefits not covered by Medicare, including medical care overseas. The bill also expanded the TRICARE retail and mail order pharmacy programs to Medicare-eligible retirees who had been limited to filling prescriptions at MTF pharmacies.

Media called the TFL win a “stunning turnaround” and reported TFL would increase the lifetime value of the military health care benefit by more than a third. Senior DoD officials called TFL “the Golden Supplement.” 

“When Congress enacted TFL, legislators and Pentagon officials alike acknowledged the statutory omission of a cash premium for TFL was to recognize career servicemembers had pre-paid steep premiums through a career of service and sacrifice in uniform,” said Col. Steve Strobridge, USAF (Ret), MOAA’s former vice president for Government Relations. “The only requirement was to enroll in Medicare Part B, as the vast majority of Medicare-eligible retirees had been doing anyway.

“From the 1990s to 2001,” Strobridge added, “we worked hard to highlight the shameful situation that the military was the only large employer in America that provided its 65-and-older retirees no employer-paid coverage beyond Medicare. Enactment of TFL and associated pharmacy  benefits transformed military retirees’ medical coverage to one of the very best.”

The TFL benefit has become even more important given the specialization and subspecialization in health care. TFL allows military retirees to access the care they need with no out-of-pocket cost for most services.

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Over the past two decades, the limitations of space-available MTF care for retirees have been underscored by medical provider deployments to support overseas operations and, more recently, the response to COVID-19. TFL has ensured all military retirees have affordable access to care even when MTF capacity is constrained.

TFL Under Attack

Since its launch in 2001, TFL has come under budgetary attack in multiple legislative cycles. MOAA has been at the forefront, working with other advocacy groups and The Military Coalition to preserve the benefit for Medicare-eligible uniformed services retirees and their families. MOAA’s advocacy efforts, including congressional testimony, statements for the record, and engagement with Armed Services Committee staff and member offices on Capitol Hill, successfully blocked five consecutive administration budget request proposals for a TFL enrollment fee in fiscal years 2013-2017.

The appropriate level of out-of-pocket costs for beneficiaries has been a topic of debate since the military health care benefit was passed into law in 1956. The creation of TFL has had a significant impact on DoD health care spending. Calls for a TFL enrollment fee and other beneficiary cost increases will likely continue in the future given DoD budget constraints.

Safeguarding TFL for a New Generation

It would be unconscionable for Congress to increase costs for Medicare-eligible military retirees who currently rely on TFL, and MOAA has successfully made that argument for many years.

Most recent proposals to cut TFL have targeted our newest generation of military retirees — equally unacceptable. Blocking proposed cuts to the TFL benefit is a top priority for MOAA. It’s as true today as in 2001 when TFL was enacted that career servicemembers and their families pay far steeper premiums than any civilian for their benefits in retirement, and they pay them upfront through extended service and sacrifice.

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The TFL benefit was a key component of the compensation and benefits package that sustained the all-volunteer force through two decades of war. Congress must not reduce the benefit just as the generation that served a full career amid high op tempo and repeated combat deployments reaches retirement. Our servicemembers earned comprehensive health care coverage and MOAA will work to ensure it is there when they need it most.

What has TFL meant for your military family? Please join us in our efforts to protect TFL by sharing your stories at legis@moaa.org.