No need for Medicare Part D
November 1st, 2010 | TriCare Help | Posted by Military Times
Q. I’ll get Medicare in January. I know I must enroll in Part A and Part B, but does Tricare require me to enroll in Medicare’s pharmacy plan, Part D?
No. The Pentagon’s Office of Health Affairs is on record as stating that the only Tricare beneficiaries who might benefit from enrollment in Medicare Part D are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums. OHA does not recommend Medicare Part D for most Tricare beneficiaries.
Some Medicare Advantage plans require enrolling in Part D. Tricare is not involved in those requirements. Medicare Part D, however, will be seen as “other health insurance,” and will prevent your using the Tricare Mail Order Pharmacy Plan. You will have to use your Part D plan first, before you can use your Tricare Pharmacy Plan, even for local drug purchases.
If you’re enrolled in Part D, you may file Tricare claims for the costs of drugs that exceed Tricare’s allowances for those drugs. But you must first buy the drugs through your Part D plan.
All Tricare beneficiaries are automatically covered for the free Tricare Pharmacy Program. The coverage, not the drugs, is free.
How does Tricare work with Medicare Part D?
February 6th, 2010 | TriCare Help | Posted by Military Times
Q. I am retired military, age 65. I know Tricare pays last, but do you have to fill prescriptions with Medicare first and then submit to Tricare for any expenses not covered? Or can I use the Tricare mail order prescription service as my preferred prescription service?
All Tricare beneficiaries are automatically eligible for, and are automatically enrolled in, the free Tricare Pharmacy Program and are eligible for its complete benefits. It is recognized as one of the best pharmacy plans available. They do not need any pharmacy insurance other than the Tricare Pharmacy Program.
You can find detailed information about the Tricare Pharmacy Program online. If you want it, additional printed information is available from the Tricare worldwide pharmacy benefit administrator, Express Scripts Inc. The toll-free number is 877-363-1303.
Health Affairs does not recommend that Tricare beneficiaries enroll in the Medicare Part D Pharmacy Program. The only Tricare beneficiaries who are likely to derive any significant advantage from Medicare Part D are the few whose incomes are below the federal poverty level and who qualify for financial aid to pay their Medicare Part B monthly premiums.
Because you have other health insurance (Medicare Part D), you are not eligible to use TMOP. That is because of the way Tricare is required by law to coordinate its benefits with Express Scripts Inc. which, for TMOP services, is not only the plan’s administrator, but also the provider of the drugs under TMOP.
When you enrolled in Medicare Part D, you had several commercial pharmacy plans to choose among, depending on where you live. Each plan has its own rules for using its benefits. You must follow that plan’s rules for all your pharmacy services and use it first, before you may use your free Tricare pharmacy plan.
You may find that your commercial plan under Medicare Part D will not pay for certain drugs. Although Tricare has special rules for dispensing certain drugs, if your doctor can document the medical necessity of that particular drug in your particular case, Tricare will make it available for you without penalties.
If your Part D pharmacy plan charges you a co-payment or a deductible for your prescription services, you may file a claim with the Tricare Pharmacy Program for partial reimbursement of those expenses.
If you have to pay a premium for the Part D pharmacy plan, however, you may not file a claim with Tricare for the premium payment. Tricare will reimburse you only for your co-payment and deductible on the cost of the drugs, but not for any cost of the insurance plan.
You will probably need help to learn how to file a claim with Tricare as second payer for your prescription drugs. I suggest you call Express Scripts for that help. If you use the Tricare Pharmacy Program exclusively, there are no claims to file.
You may also want to discuss with Express Scripts your need, or the advisability, of continuing to be enrolled in Medicare Part D. Call Medicare if you choose to withdraw from your Medicare Part D enrollment. It is easy to do, and there is no penalty.