What You Should Know About Medicare Part D

About Medicare Part D

Medicare prescription drug coverage is insurance provided by private companies approved by Medicare. The program became available to everyone with Medicare on January 1, 2006 and requires payment of a monthly premium. Individuals with limited income and resources may qualify for assistance from Medicare.

While this is not a TriWest- or TRICARE-sponsored program, some beneficiaries’ TRICARE coverage has been affected, because some dual-eligible (Medicare and TRICARE) beneficiaries have been automatically enrolled in Medicare prescription drug coverage (Medicare Part D).

Auto-enrollments

According to Medicare, individuals automatically enrolled in Medicare Part D qualified for both Medicare and Medicaid, and were sent a letter from Medicare highlighting their new prescription drug coverage options.

How Does Medicare Part D Affect My TRICARE Coverage?

If you choose to purchase Medicare Part D, Medicare is then the primary payer and TRICARE, as second payer, will pay out-of-pocket expenses (deductible and cost shares) for TRICARE-covered medications. You will be required to submit a separate claim to WPS TDEFIC (TRICARE Dual-Eligible Fiscal Intermediary Contract); however, TRICARE will not reimburse you for the monthly Part D premium.

Is Medicare Part D Necessary?

Unlike many non-DoD Medicare beneficiaries, TRICARE beneficiaries already have a robust pharmacy benefit with no monthly premium and minimal copays for prescriptions filled at TRICARE retail network pharmacies, and no costs for prescriptions filled at military treatment facilities. Express Scripts offers the TRICARE Mail Order Pharmacy (TMOP) program, which can save you up to 66 percent off what you pay for prescriptions at a retail pharmacy.

For nearly all TRICARE-Medicare dual-eligible beneficiaries, under most circumstances, there is no added value in purchasing Medicare Part D. There may be an exception to this general rule for those with limited incomes and assets who qualify for Medicare assistance.

How Can I Disenroll From Medicare Part D?

If you have been involuntarily enrolled in Medicare Part D, you may be able to disenroll by calling Medicare at 1-800-MEDICARE (1-800-633-4227). Medicare Part D is a Medicare program; therefore TRICARE and TriWest cannot disenroll beneficiaries from Part D coverage.

Part D disenrollment can only occur during certain "enrollment periods," such as the Annual Coordinated Election Period (AEP), November 15 - December 31 of each year. During the AEP, everyone who is Medicare-eligible can enroll in a Part D plan for the first time, switch to a new Part D plan, or disenroll from their current plan. Please contact Medicare at 1-800-MEDICARE (1-800-633-4227) to enroll, disenroll, or for information on additional enrollment periods.

Further questions regarding Part D enrollment, including enrollment status, should be directed to Medicare: 1-800-MEDICARE (1-800-633-4227). 

For more information about the TMOP program, please call Express Scripts at 1-866-DOD-TMOP (1-866-363-8667).

For information about the DoD TRICARE Retail Pharmacy program, call 1-866-DOD-TRRX (1-866-363-8779).