TRICARE beneficiaries have a robust pharmacy benefit with no monthly premium and minimal copayments. For nearly all TRICARE-Medicare beneficiaries, under most circumstances, there is no added value in purchasing Medicare prescription drug coverage. The exception to this general rule may be if you have limited income and assets and qualify for Medicare’s Extra Help with prescription drug plan costs. In that case, you may benefit by enrolling in a Medicare prescription drug plan.
TRICARE-Medicare beneficiaries who enroll in a Part D prescription drug plan must pay the monthly Medicare prescription drug plan premium; TRICARE does not reimburse Medicare premium costs. If you are a TRICARE-Medicare eligible beneficiary and enroll in a Medicare Advantage drug plan, you pay the monthly premiums and receive all your medical care and prescription drugs through the Medicare Advantage plan.
If a TRICARE-Medicare eligible beneficiary enrolls in a stand-alone Part D prescription drug plan, Medicare is primary and TRICARE Pharmacy, as second payer, will help pay your out-of-pocket costs for TRICARE-covered medications, as well as the Medicare prescription drug plan deductible and cost sharing amounts. TRICARE drug costs do not count toward meeting the Medicare prescription drug plan out-of-pocket limit. Once the TRICARE catastrophic cap ($3,000/fiscal year for family members and all TRICARE beneficiaries that are not active duty) is met, TRICARE pays 100 percent of your prescription drug costs.
TRICARE Pharmacy coverage is considered creditable coverage because it pays, on average, at least as well as or better than Medicare prescription drug coverage. Therefore, the late enrollment fee will not apply if you decide to enroll in Medicare prescription drug coverage after the open enrollment period. If you lose your TRICARE eligibility (for example, due to divorce, remarriage and so forth), you have 63 days to enroll in Part D of Medicare without paying the premium penalty. If you don’t enroll in a Medicare prescription drug plan during the 63-day period, you will have to wait to enroll in a Medicare prescription drug plan during the next annual enrollment period.