Q: I have TRICARE for Life because my deceased husband was retired from the military. It is my understanding that I do not need the new Medicare drug coverage. Is this correct?
A: In most cases, yes. Effective January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. That includes people under TRICARE for life, the system that covers military retirees. According to a TRICARE fact sheet, as long as you still qualify for TRICARE, it will almost always be to your advantage to continue your current TRICARE drug coverage instead of signing up for a Medicare Part D plan.
The exception to this general rule is for persons with limited incomes and assets who qualify for Medicare’s "extra help" with prescription drug costs. For TRICARE beneficiaries who qualify, the extra Medicare assistance helps pay for most or all of the Part D premiums, deductible, and copays. For more eligibility information and to apply online you can go to www.ssa.gov or call Social Security toll free at 1-800-772-1213.
The chart below is from the TRICARE Tip Sheet on the new Medicare prescription drug coverage and illustrates the difference between TRICARE Pharmacy Benefits and Medicare Part D.
TRICARE Pharmacy Medicare Prescription Drug Coverage
Beneficiaries must be registered in the Defense Enrollment Eligibility Reporting System. Beneficiaries must also be enrolled in Medicare Part B if age 65 except for active duty family members. All Part A and or Part B enrollees living in the U.S. are eligible.
No enrollment necessary Annual open enrollment period. Enrollment is voluntary but the government will apply a penalty for late enrollment.
Uniform national formulary Covered drugs vary by drug plan.
Nationwide network of pharmacies and mail-order pharmacy benefit. Pharmacies vary by drug plan.
Beneficiary costs:
- No monthly pharmacy premiums
- No deductible for retail network pharmacies or mail orders
- Standardized copays, $3 for generic formulary, $9 for brand name formulary, and $22 for non-formlary, no copays at MTFs
- Deductible and higher copays when using non-network retail pharmacies
- $3,000 maximum out-of-pocket for medical and drug costs
- $1,000 maximum out-of-pocket for active duty family members Beneficiary costs (for standard coverage; actual plan designs vary)
- National average monthly premium about $32 in 2006, will be adjusted annually.
- $250 standard ( but varies) deductible
- 25% for the first $2,250 in drug costs (actual plans tend to have fixed copays)
- $3,600 out-of-pocket costs for drug costs alone
February 2006
