Medicare Part D Prescription Drug Benefit

Starting January 1, 2006, the Medicare prescription drug coverage becomes available to everyone with Medicare Part A and/or Part B. Beneficiaries that live overseas or are in prison are not eligible for the Medicare pharmacy program. 

For nearly all TRICARE-Medicare beneficiaries, under most circumstances, there is no added value in purchasing Medicare prescription drug coverage if you have TRICARE. The exception to this general rule may be for those with limited incomes and assets who qualify for Medicare's extra help with prescription drug plan costs; such individuals may benefit by enrolling in a Medicare prescription drug plan.

TRICARE-Medicare eligible beneficiaries, entitled to the TRICARE Pharmacy benefit, need to consider a number of factors when deciding whether or not to enroll in a

Medicare drug plan. They should consider monthly premiums, deductibles, co-pays and drug coverage under the different prescription drug plan options offered (also known as a formulary), including the TRICARE Pharmacy Program. The Medicare Part D drug plan options will vary by location.

Enrollment and Premiums

People with Medicare Part A and/or Part B can enroll in a Medicare prescription drug plan during the intitial open enrollment period (November 15, 2005 - May 15, 2006). Each following year, you will have the option to enroll in a Medicare prescription drug plan between November 15th and December 31st. Beneficiaries that enroll in a Medicare prescription drug plan are responsible for paying the monthly premium. TRICARE does not reimburse Medicare premiums. 

 If you have limited income and resources, you may qualify for extra help paying for the Medicare prescription drug premiums, deductible and cost shares. For more information on who can get extra help with prescription drug costs and how to apply, call the Social Security Administration at 1-800-772-1213, or visit www.socialsecurity.gov on the web. TTY users should call 1-800-325-0778.

Creditable Coverage

TRICARE pharmacy coverage is considered creditable coverage since it pays, on average, as much or more than the standard Medicare prescription drug coverage. View a copy of the letter of credible coverage sent to TRICARE beneficiaries. Because TRICARE Pharmacy is creditable coverage, TRICARE beneficiaries are not required to enroll in a Medicare prescription drug plan. If you, as a TRICARE-eligible beneficiary, decide to enroll in a Medicare prescription drug plan, after May 15, 2006, the late enrollment penalty will not apply. 

If TRICARE eligibility is lost (for example, due to divorce, remarriage, etc.), you will have a Medicare prescription drug special enrollment period which begins the day you lose TRICARE coverage and ends 62 days after you lose TRICARE coverage.

Penalties

If you don't enroll in a Medicare prescription drug plan during the 62 day period, you will have to wait to enroll in a Medicare prescription drug plan during the next general enrollment period, which is November 15 through December 31st each year. Your Medicare prescription drug monthly premium will go up at least 1% for every month after May 15, 2006 that you did not have creditable coverage. The Medicare prescription drug coverage will be effective January 1 of the following year.

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