TRICARE strives to offer a worldclass health care benefit that meets all the needs of our beneficiaries. TRICARE covers most inpatient and outpatient care that is medically necessary and considered proven. TRICARE also offers supplemental programs for health care needs that go beyond the basic TRICARE program options. This section highlights some of the features of TRICARE coverage, including some supplemental programs that may be available to you, such as the TRICARE Dental Program and the Extended Care Health Option.
Catastrophic Cap The TRICARE catastrophic cap limits your out of pocket expenses on annual deductibles, cost shares, and other costs (such as those for pharmacy) for TRICAREcovered medical services and supplies. As a TRICARE beneficiary, you will not be responsible for any costshares over the catastrophic cap total in a given fiscal year (October 1–September 30).Refer to the TRICARE: Summary of Beneficiary Costs Flyer for the catastrophic cap by beneficiary category.
Note: The catastrophic cap does not apply to services that are not covered or to the additional 15 percent that nonparticipating providers may charge above the TRICARE allowable charge or POS charges.
Pharmacy Services TRICARE offers comprehensive prescription drug coverage and several options for filling your prescriptions. To have a prescription filled, you’ll need a written prescription and a valid uniformed services ID card. Refer to the TRICARE: Summary of Beneficiary Costs Flyer or www.tricare.mil/pharmacy for pharmacy cost information.
Military Treatment Facility Pharmacy Prescriptions may be filled (up to a 90 day supply for most medications) at no cost at an MTF pharmacy, as long as the medication is on the MTF formulary. You should contact the MTF to find out what is on the formulary and for specific details about filling prescriptions at the MTF pharmacy. If you do not live near an MTF, this may not be your best option for filling prescriptions.
TRICARE Mail Order Pharmacy The mailorder pharmacy is your least expensive option when not using an MTF. You may receiveup to a 90 day supply for most medications, which will be delivered to your home for a smallcopayment. Refills may be requested by mail, phone, or online. For faster processing of your mailorder prescription, you can register before placing your first order. Once you are registered, your provider can fax or call in your prescriptions.
Medications will be sent directly to your home in about 14 days after receiving your prescription. If you have prescription drug coverage from another health insurance plan, you can only use the mailorder pharmacy if the medication is not covered under the other plan or if you have exceeded the dollar limit of coverage under the other plan. For more information regarding the mailorder pharmacy, please contact Humana Military or visit TRICARE's Pharmacy information.
TRICARE Retail Pharmacy Network You can have prescriptions filled (up to a 30 day supply) at any pharmacy in the TRICARE retail pharmacy network for a small copayment. For more information on locating a TRICARE retailnetwork pharmacy, please contact your Humana Military or visit TRICARE's pharmacy information.
Non-network Pharmacies Filling prescriptions at a nonnetwork pharmacy is the most expensive option. You may have to payfor the total cost of the prescription first and then file a claim to receive a partial reimbursement afteryour deductible is met.
Important Note about Medicare Part D: As a beneficiary eligible for TRICARE and Medicare, and entitled to the TRICARE pharmacy benefit, you need to consider a number of factors when deciding whether or not to enroll in a Medicare drug plan. You should consider monthly premiums, deductibles, copayments, and drug coverage (also known as a formulary) under the different plans offered. The Medicare Part D drug plans vary by state.
In most cases, beneficiaries eligible for both TRICARE and Medicare will get no added value by purchasing Medicare prescription drug coverage. The exceptions are those with limited incomes and assets who qualify for Medicare’s extra help with prescription drug plan costs.
Contact your local State Health Insurance Assistance Program (SHIP) for free health insurance counseling and assistance. Call Medicare at 1-800-633-4227 for the number of your local SHIP agency.
