Medicare Part D and TRICARE
Medicare Part D prescription drug coverage is available to everyone with Medicare, including TRICARE beneficiaries. Since you are required to sign up for Medicare Part B or risk losing your TRICARE coverage, you may wonder if you should sign up for Medicare Part D since you already have prescription coverage under TRICARE.
We will explain exactly what is covered under each program, the costs and limitations, and recommend what you should do.
- What is Medicare's Drug Coverage?
- What is TRICARE's Drug Coverage?
- Should TRICARE Eligible Beneficiaries Sign Up For Medicare Drug Coverage?
Medicare's drug coverage is also known as Medicare Part D. Medicare Part D is offered by private insurance companies, so the costs and coverage vary by plan.
- Monthly premium about $34 which varies by plan and is adjusted annually
- There is a $400 deductible on prescriptions (you pay this out-of-pocket before Medicare pays anything)
- After paying the first $400, you pay a 25% copay for the price of drugs until the total cost reaches $3,700
- You pay 100% of the cost of prescribed drugs from $3,700 to $7,425 per year (this is known as the Medicare donut hole)
- After $7,425, you pay the greater of $3.30/$8.25 copay or 5% for rest of calendar year
TRICARE offers drug coverage as a part of its normal insurance programs, (prime, standard, etc. ). If you are retired and enrolled in TRICARE for Life you automatically get prescription drug coverage at no additional cost. If you are taking maintenance drugs, such as blood pressure medication, cholesterol medication, etc. you must get it filled via TRICARE's mail order pharmacy. If you need drugs for acute care, such as after surgery, etc. you can get them at your local pharmacy or on base. Either way, TRICARE pays for them. You will normally be responsible for a co-pay.
At a military pharmacy you can normally get up to a 90 day supply for free. At a network pharmacy you will normally get pay $10 for a 30 day supply of generic drugs, $24 for brand name drugs, or $50 for non-formulary drugs. If you choose home-delivery you can get up to a 90 day supply of generic drugs for free, $20 for brand name, or $49 for non-formulary.
It will almost always be to your advantage to keep TRICARE pharmacy benefits over Medicare Part D. However, if you have limited income and resources, you may qualify for extra help from Medicare. Check out medicare.gov for more information.