Tricare Help - Tricare pharmacy coverage needs no help from Part D

Since 12-03-05

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Subject: Tricare Help: Tricare pharmacy coverage needs no help from Part D

Tricare Help: Tricare pharmacy coverage needs no help from Part D

By James E. Hamby Jr.
Special to NavyTimes
December 5, 2005

Q. We are deluged with fliers wanting to sell us Medicare Part D. I know you have written that those of us with Tricare for Life don’t need Part D, but the brochures keep coming in. It’s all so confusing. What should I do?

A. When Washington made an important Medicare benefit — drug coverage — a commercial venture, almost every drug management company jumped on the money train. I’m afraid the fliers and television ads will only increase until everybody is signed up with somebody.

So let me say it again. Nobody with Tricare pharmacy coverage needs Medicare Part D or any other pharmacy patchwork. The Tricare Pharmacy Plan needs no help.

Under the Tricare Mail Order Pharmacy Plan, you can buy a 90-day supply of a generic drug for $3. If you take one pill a day, 90 pills will cost $3.

If you take three of the pills per day, 270 pills, your cost is still $3. If your doctor says you must take the brand-name form of the drug, you will get the same deal, except that it will cost $9 instead of $3.

By using Tricare, you can buy the same pills more cheaply than from the drug vendors.

http://www.tricare.osd.mil/medicarepartd/

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Q. My wife and I plan to spend a few years seeing America in our RV. We have Tricare Prime at our military hospital. How well will it work for us on the road?

A. Tricare Prime is great for people who live near a military hospital or other military treatment facility. They get priority access to free care without concerns about space availability (usually); drugs are free; even a stay in a civilian hospital is dirt cheap. But Tricare Prime is not a good choice for people who travel frequently and range far from their primary care manager, or PCM.

Anytime you get non-emergency care from a provider that is not your PCM, or if your PCM did not refer you to that provider, your claim falls under the Tricare Prime Point of Service Option, called POS. A Tricare claim for those services will have an automatic $300 deductible. And then, if there is anything left for Tricare to pay on, you will have a 50 percent cost share on whatever Tricare allows.

If you have to be hospitalized, the 50 percent cost share can put an end to your travels for a long while because, unlike Tricare Standard or even Tricare Prime, there is no catastrophic cap on deductibles and cost shares under the POS.

Ordinarily, when a family has paid $3,000 in cost shares and deductibles in a fiscal year, the catastrophic cap is activated. Tricare will pay 100 percent of the amount it allows on each claim. No more cost shares will be withheld from Tricare’s payments for the rest of that fiscal year.

That is not the case under the Tricare Prime POS. There is no limit to the amount of cost shares you can be responsible for paying.

Tricare Prime members have priority access to military medical care only at their home base. At any other military hospital, they are subject to space-available considerations as if they were not enrolled in Prime.

So, the best thing for travelers like you is Tricare Standard plus a good Tricare supplement from a recognized insurer.

James E. Hamby Jr. may be reached by writing to

Tricare Help,
Times News Service,
6883 Commercial Drive,
Springfield, VA 22159;
or by sending e-mail to tricarehelp@atpco.com .
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Contributed,
YNCS Don Harribine, USN(ret)