TRICARE For Life does not cover custodial long-term care — not in a nursing home, not in assisted living, and not for an aide at home — and a retired service member who has been told otherwise is about to make an expensive planning error. TFL is excellent coverage for what it does. It wraps around Medicare, it has famously low out-of-pocket costs, and it follows you for life. It is simply not a long-term care benefit, and no amount of service time changes that.
The confusion is understandable. Military retirees spend a career with medical care handled, then reach the age where the bills that matter are not medical at all — they are for help with bathing, dressing, supervision and safety. Those are custodial services, and custodial care is excluded from Medicare and, by extension, from the wraparound that follows Medicare’s rules.
So this page is a call list. Five calls, in order, with the exact question to ask each one. Work it in sequence, because the answer from each call changes what you ask the next. Pine Lake Legacy provides education and a free policy review only; nothing here is legal, tax or benefits advice.
In This Article
Call One: DEERS, Before Anything Else
Ask exactly this: “Is every family member’s DEERS record current, and does it show Medicare Part A and Part B enrollment for anyone eligible?”
This is first because everything downstream fails without it. TRICARE For Life eligibility generally requires enrollment in Medicare Part A and Part B for those entitled to premium-free Part A. A retiree who declined Part B, or a spouse whose record was never updated after a move, a marriage, a divorce or a death, can find TFL simply does not pay — and the fix is retroactive paperwork under time pressure.
Update DEERS through the milConnect portal or an ID card office. While you are in there, verify addresses and confirm each beneficiary’s status.
Then call the TRICARE For Life claims contractor. TFL claims are processed by Wisconsin Physicians Service under contract with the Defense Health Agency, and that is the office that can tell you what TFL paid on a specific claim and why. Ask them the second question of this call: “What is our catastrophic cap status this year?” TRICARE applies an annual catastrophic cap that limits a family’s out-of-pocket costs for covered services in a benefit year — it does not apply to services TRICARE does not cover, which is exactly the point of this page, but knowing where you stand is useful.
Call Two: Medicare and a SHIP Counselor
Ask exactly this: “What will Medicare cover in this situation, for how many days, and what does TRICARE For Life pick up after that?”
The structure is simple once stated: Medicare is generally the primary payer and TFL is the second payer for services both cover, which is why TFL beneficiaries often see very small bills. Where Medicare covers nothing, TFL as second payer generally has nothing to follow.
The concrete numbers to get on this call. Medicare covers a skilled nursing facility stay after a qualifying three consecutive day inpatient hospital stay, up to 100 days per benefit period, with no coinsurance days 1 through 20 and a daily coinsurance for days 21 through 100 that the Centers for Medicare & Medicaid Services updates each January — it ran a little over $200 a day for 2025. TFL commonly covers that coinsurance for a Medicare-covered stay, which is a real and meaningful benefit. What neither covers is the long stay that begins when the skilled need ends.
Also ask about home health, which Medicare covers for a homebound patient needing intermittent skilled care, and which does not include the custodial hours families actually need.
Your State Health Insurance Assistance Program counselor is free, unbiased, sells nothing, and does this every day. Use them rather than an insurance agent for this call. Read what a long-term care ombudsman does as well, since that is the free advocate once someone is in a facility.
Call Three: The VA, Through an Accredited Service Officer
Ask exactly this: “Which VA long-term care benefits is this veteran eligible for, and what is the current Aid and Attendance rate and net worth limit?”
This is where actual long-term care money exists for many military families, and it is a completely separate system from TRICARE. Do not conflate them.
Three programs to ask about by name. Aid and Attendance is an increased monthly pension amount for a wartime veteran or surviving spouse who meets service, income, net worth and disability criteria and who needs help with daily activities. The maximum annual pension rates and the net worth limit are adjusted annually by the Department of Veterans Affairs, so ask for the current figures rather than relying on any number you read anywhere. VA community living centers and state veterans homes provide nursing care, with the VA paying a per diem to state homes. The VA’s home and community based services, including homemaker and home health aide services, adult day health care, respite and the Veteran-Directed Care program, which gives a budget the veteran directs.
Use a VA-accredited representative — a Veterans Service Organization service officer, a state or county veterans service officer, or an accredited attorney or agent. Their help is generally free, and accreditation matters: charging a fee to prepare an initial claim is restricted, and unaccredited “pension poaching” operations that pitch asset transfers to qualify for Aid and Attendance are a known problem. Read how VA benefits interact with life insurance before any conversation about moving assets.
| Order | Who to Call | The Exact Question |
|---|---|---|
| 1 | DEERS via milConnect, then the TFL claims contractor | Are records current and is Medicare Part B enrollment shown? |
| 2 | Medicare and a SHIP counselor | What does Medicare cover, for how long, and what does TFL pick up? |
| 3 | A VA-accredited service officer | Which VA long-term care benefits apply, and at what current rates? |
| 4 | State Medicaid agency | Resource limits, burial exclusion, and how VA income counts |
| 5 | Every insurance carrier | Riders, cash surrender value, and the paid-through date |
Call Four: The State Medicaid Agency
Ask exactly this: “What are the current income and resource limits for long-term care Medicaid in this state, what is the burial exclusion, and how does VA pension income count?”
Medicaid is the payer of long-term custodial care in the United States, for veterans as for everyone else. TRICARE For Life does not change that and does not conflict with it.
Three things to establish on this call. The countable resource limit for a single applicant and the spousal impoverishment figures — the Community Spouse Resource Allowance and the Minimum Monthly Maintenance Needs Allowance — which CMS updates annually and which states set within federal bounds. The state’s burial exclusion for life insurance face value and for burial funds. And how the state treats VA benefits, because the interaction between VA pension, Aid and Attendance and Medicaid patient liability is genuinely complicated and state-specific.
Ask also about the 60-month look-back, because the pension-poaching pitch mentioned above frequently creates a Medicaid transfer penalty in exchange for a VA benefit, which is a bad trade for most households. See how the Medicaid look-back period works.
The cost frame that makes this urgent: nursing facility care ran roughly $8,000 to $10,500 a month in 2024 and 2025 cost-of-care surveys, assisted living roughly $5,000 to $6,500, and home health aide time roughly $30 to $38 an hour. Confirm local figures directly with the providers you are considering.
Call Five: Every Insurance Carrier in the Household
Ask exactly this: “What riders does this contract contain, what is the current cash surrender value, and what is the paid-through date?”
Three kinds of policy turn up in military households and each has a different answer.
A standalone long-term care policy or a hybrid life and long-term care contract. If one exists, it is the most valuable document in the house. Ask for the benefit trigger definition, the elimination period, the daily or monthly benefit, whether there is inflation protection, and the claim filing process. Read how a hybrid long-term care policy works. Note that the Federal Long Term Care Insurance Program, which served federal and uniformed services populations, suspended new enrollments in December 2022 and that suspension has been extended — existing enrollees should confirm their own policy status directly with the program administrator.
An SGLI-derived or VGLI policy. Servicemembers’ Group Life Insurance converts to Veterans’ Group Life Insurance after separation, with its own application deadline. VGLI premiums rise with age brackets and become expensive in the seventies and eighties, which is when households start asking whether to drop it. Before dropping anything, ask about the conversion right to an individual commercial policy.
An old permanent policy. Ask for an in-force illustration. It shows the cash value and how long the policy is projected to last at the current premium, and it is free.
On the settlement question, be clear about when it does not apply. Selling is the wrong answer when the face amount is under roughly $100,000, because the secondary market rarely bids at that size and most VGLI and group amounts held into late life are modest; when the policy sits inside a Medicaid burial exclusion; when the insured is in good health, which lengthens projected life expectancy and compresses offers; and when a surviving spouse still needs the death benefit — which in a military household often means the survivor whose Survivor Benefit Plan annuity does not cover everything. Where a large permanent policy is genuinely unaffordable and health has declined, a free review will tell you what it is worth; see how a settlement compares with a long-term care rider. Send the policy cover page or call (732) 978-9575. Pine Lake Legacy does not purchase policies and is not licensed in every state.
The Order Matters: What Each Call Changes
A short summary of why the sequence is what it is.
DEERS first because a lapsed or inaccurate record makes every other TRICARE answer wrong, and correcting it takes time you may not have later.
Medicare and SHIP second because they define the boundary of what is covered at all, and everything else is funding for what falls outside that boundary.
The VA third because Aid and Attendance and the VA’s home and community based services are real money that many eligible households never claim, and because the application takes months — file early even if you are not yet certain.
Medicaid fourth because it is the payer of last resort by design, and because the planning it requires interacts with the VA answer you just got.
The carriers fifth because you now know what gap you are actually filling, and you will not surrender or sell a policy to solve a problem that a benefit already covers.
One last practical note that applies to every household on this page: protect the policies you already own while all of this is happening. Change addresses with every carrier when someone moves, move premiums to a bank draft on a dedicated account, and file a third-party lapse-notice designation so a spouse or adult child also receives lapse notices. A policy generally lapses about 31 days after a missed premium, and a lapse destroys surrender value, sale value and the death benefit together. Read what a life care plan is if the care needs are complex enough to warrant a formal projection.
Frequently Asked Questions
Does TRICARE For Life pay for a nursing home?
Not for custodial long-term care. TRICARE For Life wraps around Medicare, so where Medicare covers a skilled nursing stay after a qualifying three-day inpatient hospital stay, TFL commonly picks up the daily coinsurance for days 21 through 100. Once the skilled need ends and the stay becomes custodial, neither program pays, and the payer becomes private funds or Medicaid.
Do I have to enroll in Medicare Part B to keep TRICARE For Life?
Generally yes for those entitled to premium-free Part A. TFL eligibility is tied to Medicare Part A and Part B enrollment, and a retiree or spouse who declined Part B can find that TFL does not pay. Verify enrollment status in DEERS through milConnect and correct any gap immediately, because retroactive fixes are slow and sometimes costly.
What VA benefits actually help with long-term care?
Ask about Aid and Attendance, an increased pension amount for eligible wartime veterans and surviving spouses who need help with daily activities; VA community living centers and state veterans homes; and VA home and community based services including homemaker and home health aide care, adult day health care, respite, and Veteran-Directed Care. Use a VA-accredited service officer, whose help is generally free.
Someone offered to help us qualify for Aid and Attendance by moving assets. Is that safe?
Be very careful. Unaccredited operations that pitch asset transfers to qualify for VA pension are a known problem, and such transfers can create a Medicaid transfer penalty under the 60-month look-back, which is usually a far worse outcome than the pension gained. Work only with a VA-accredited representative and consult an elder law attorney before moving any asset.
What happened to the federal long-term care insurance program?
The Federal Long Term Care Insurance Program suspended new enrollments in December 2022 and the suspension has been extended. Existing enrollees should confirm their own policy status, premium schedule and benefit terms directly with the program administrator rather than assuming. If a private long-term care or hybrid policy exists in the household, it is the most valuable document you own.
Should we sell a life insurance policy to pay for care?
Check the covered benefits first, because several calls on this list may fund the need at no cost. Selling is the wrong answer for face amounts under roughly $100,000, for policies inside a Medicaid burial exclusion, for a healthy insured, and where a surviving spouse still needs the benefit, which is common where a Survivor Benefit Plan annuity does not cover everything.
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Related Reading
- Life Settlement Vs Long Term Care Rider
- Long Term Care Hybrid Policy
- What Is A Long Term Care Ombudsman
- What Is A Life Care Plan
- Traumatic Brain Injury Long Term Care
- Va Benefits And Life Insurance
- What Is The Medicaid Look Back Period
Pine Lake Legacy does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.