Do I need Part D when I turn 65?
April 26th, 2012 | TriCare Help | Posted by Military Times
I am a Navy retiree who will turn 65 next year. Like many of your readers, I understand the basics of Tricare, and what it does and does not cover. What I have never seen addressed is “Part D,” or coverage for prescriptions. Can you briefly address that?
Our Tricare Help column has addressed that topic a number of times in the past. But Part D is not a Tricare program — it’s the prescription drug program under Medicare. The consistent advice from the Defense Department’s Office of Health Affairs is that virtually no one who is eligible for Tricare for Life — which you will be when you turn 65 — needs Medicare Part D prescription drug coverage.
Out-of-pocket co-pays for prescription drugs under Part D are usually higher than under Tricare for Life. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
The Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums.
How can I get information on Medicare Part C?
April 20th, 2012 | TriCare Help | Posted by Military Times
I turned 65 in February and have enrolled in Medicare Parts A and B. I have also contacted Medicare about information on Part C, but it’s been three weeks and I have not heard back. Can you help?
I can’t help get you a reply from Medicare — that’s outside the scope of the Tricare Help column. But I can tell you that as a general rule, Tricare for Life beneficiaries do not need Medicare Part C coverage.
Medicare Advantage Plans under Part C are offered by private companies that are approved by Medicare. They may offer supplemental coverage beyond the standard Medicare Parts A and B, and most also offer Medicare Part D prescription drug coverage — all at additional out-of-pocket costs to beneficiaries beyond the monthly premiums required for Medicare Part B outpatient coverage.
Advantage plans, however, are designed for civilians who do not have your free Medicare supplement known as Tricare for Life. TFL offers the same supplemental coverage, along with its own prescription drug plan, at far less cost. While there has been talk of implementing an annual enrollment fee for Tricare for Life, at this time there are no enrollment costs for the Tricare portion of TFL.
In addition, prescription drug costs through TFL are less costly than under Medicare Part D. In fact, the Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
To sum up, you are already covered by two full-service, stand-alone, health insurance plans — Medicare and Tricare for Life — all for the cost of the monthly premium for Medicare Part B.
Do Medicare-eligible Tricare beneficiaries need Part D?
April 13th, 2012 | TriCare Help | Posted by Military Times
My wife will get Medicare this summer, and her sister told her that she will have to enroll in the Medicare Pharmacy Program, or Part D. Is that correct?
Unless your wife enrolls in one of the Medicare Advantage plans that requires it, she is not required to enroll in Medicare Part D.
Neither Medicare nor Tricare require their beneficiaries to enroll in the Medicare Pharmacy Plan, Part D of Medicare. To the contrary, Medicare Part D is not recommended for Tricare for Life beneficiaries.
The Office of the Assistant Secretary of Defense for Health Affairs is on record for saying that the only Tricare beneficiaries likely to achieve any financial advantage from Medicare Part D enrollment are those whose incomes are below the federal poverty level and who qualify for financial aid to help pay their Medicare Part B premiums.
If your wife were to enroll in a Medicare Part D plan, she would have to file Tricare claims to be reimbursed for the plan’s copayments and deductibles, if applicable. She might be limited to that plan’s formulary in the drugs that are covered, and she would not be eligible to use the Tricare Pharmacy Program’s Mail Order Pharmacy Plan.
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.