If TRICARE-Medicare beneficiaries enroll in a prescription drug plan that adds prescription coverage to the original Medicare plan, Medicare is primary and TRICARE, as second payer, will pay their out-of-pocket costs for TRICARE-covered medications and the Medicare deductible and cost shares. When beneficiaries become responsible for 100 percent of the drug costs under the Medicare Part D drug plan, the TRICARE pharmacy benefit becomes primary payer and the beneficiary is responsible for applicable TRICARE pharmacy copays and cost shares. Once the TRICARE catastrophic cap is met, TRICARE pays 100 percent for TRICARE-covered medications.
Differences Between TRICARE and MEDICARE
The aim of TRICARE is to provide those with links to the military with civilian health care. Interestingly, TRICARE doesn’t apply only to service members, but also to veterans, to the families of veterans and in some cases to civilian employees of the military. In essence, the program is there to ensure that people within the military and with ties to the military have more options when it comes to health care. TRICARE has gone through a number of changes since its foundation as CHAMPUS and beyond, so it can get a little confusing. The program can be broken down as follows:
TRICARE for Life Medicare Options
TRICARE for Life is a type of Medicare Supplement plan available only to those with both Medicare and TRICARE coverage (i. e. , current or former military personnel and dependents). If you are part of both programs, you should automatically be enrolled in TRICARE for Life. If you have TRICARE for Life, TRICARE serves as a secondary payer and provides additional benefits after Medicare has paid its share for Medicare-covered services. Many services covered by both Medicare and TRICARE for Life may cost you nothing out-of-pocket. However, you may choose to purchase a Medigap or Medicare Advantage plan to supplement TRICARE for Life.
Medical Benefits in Retirement – TRICARE For Life and Medicare
Part B covers most of the costs associated with physician fees, lab fees and durable medical equipment costs. Typically, Part B will pay 80 percent of the costs of these services, and leave you with 20 percent of the tab, though some services have a higher coinsurance amount. You’re automatically enrolled when you turn 65, in most cases. There is a premium for Part B coverage, though: $99.90 per month. There’s also an annual deductible of $140 every year.
Tricare Program and Benefits
TRICARE Plus: The TRICARE Plus program is a local military treatment facility (MTF) based primary care enrollment program and not a comprehensive health care program. TRICARE eligible beneficiaries not enrolled in TRICARE Prime will be given the opportunity to enroll for MTF primary care. TRICARE Plus members receive primary care appointments within the TRICARE access standards. It includes designation of a primary care provider and use of referral procedures for specialty care, when available, in the MTF or civilian network. TRICARE Plus enrollment will be annotated in DEERS. For care from civilian providers, TRICARE Plus has no effect and TRICARE Standard/Extra rules will apply for most enrollees. For services payable by Medicare, Medicare rules will apply with TRICARE as second payer for TRICARE covered services and supplies. Specialty care in the MTF will be based on referrals from the primary care provider. There is no lock-in and no enrollment fee for TRICARE Plus.