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, including the costs and limitations, and recommend what you should do.
What is Medicare's 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.
- The Centers for Medicare and Medicaid Services project that monthly premiums will average $55.50 in 2024, although they vary.
- There is a maximum $545 deductible on prescriptions (deductibles vary by plan; you pay this out of pocket before Medicare pays anything).
- Copays initially vary by plan. After you and your plan pay a combined $5,030 in 2024, you'll pay no more than a 25% copay for the price of drugs until the total cost reaches $8,000.
What is Tricare's Drug Coverage?
Tricare offers drug coverage as a part of its normal insurance programs (Prime, Select, 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, 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 retail in-network pharmacy, you will normally pay $16 for a 30-day supply of generic drugs, $48 for brand name drugs, or $85 for non-formulary drugs. If you choose home-delivery you can get up to a 90-day supply of generic drugs for $14, $44 for brand name, or $85 for non-formulary.
Should Tricare Beneficiaries Sign up for Medicare Part D?
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.
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