Tricare for life prescription question

[jack3454]

Does anyone know if someone has tricare for life and a MA only plan, they can still use their tricare for prescriptions, correct? In other words the MA only plan doesn't completely remove the tricare prescription coverage that a person has, only if they sign up for a MAPD right?

 

[Fisher]

MA-only plans have no Rx coverage (as you know) and that is the exact reason you ONLY use MA plans for Tricare folks. Never EVER put a T4L person on an MAPD plan.

This is one of the rare circumstances where I will make an absolute statement.

 

[jack3454]

So just to confirm 100% the tricare drug coverage is still used on a MA-only plan?

 

[Fisher]

100% confirmed.

 

[Special Agent]

MA-only plans have no Rx coverage (as you know) and that is the exact reason you ONLY use MA plans for Tricare folks. Never EVER put a T4L person on an MAPD plan.

This is one of the rare circumstances where I will make an absolute statement.

That's what i always thought however I met with a Tricare couple recently he had mapd said his mapd is helping pay part of drug cost.he showed me this so i didn't switch him to the MA only with part B rebate.looks like his mapd may be pitching in? I know if they get rx at the base then a mapd will definitely is not helpful because all rx are 0 at base with tricare but if they use local pharmacy i am starting to wonder after seeing this statement.client did mention goes through a bit of a rigmarole at the pharmacy counter to get this to work though.

 

[Fisher]

That statement doesn't show what the benefit to the client is. The amount paid by the MAPD appears to be going to the pharmacy (makes sense) but how does the client come out ahead by having the MAPD?

 

[ValeRosso]

@Special Agent
But this doesn't show what the MAPD paid, unless its referring to the "other insurance paid" which it very well could be the MAPD. It looks from this doc that Tricare is paying primary for these Rx and not the MAPD.

I know some provider offices will submit claims to Tricare as well as the MA plan, just gotta find a good provider who will do this. AFAIK client will pay copays and then get reimbursed from Tricare, but I don't know how this works with prescriptions with Tricare and MAPD.

 

[Special Agent]

That statement doesn't show what the benefit to the client is. The amount paid by the MAPD appears to be going to the pharmacy (makes sense) but how does the client come out ahead by having the MAPD?

column where it says beneficiary paid.is this not what tricare beneficiary would normally pay at local pharmacy? asking and trying to learn because this is actually the first time i have seen a tricare rx statement but based on what tricare people tell me they do usually have some compayments when not using the tricare mail order or filling tx at the base.I would still recommend an ma only to tri care prospect if suitable but in this case i didn't want it to cost him at the pharmacy counter if he switched from his mapd

 

[Special Agent]

@Special Agent
But this doesn't show what the MAPD paid, unless its referring to the "other insurance paid" which it very well could be the MAPD. It looks from this doc that Tricare is paying primary for these Rx and not the MAPD.

I know some provider offices will submit claims to Tricare as well as the MA plan, just gotta find a good provider who will do this. AFAIK client will pay copays and then get reimbursed from Tricare, but I don't know how this works with prescriptions with Tricare and MAPD.

client said it is a bit of hoop jumping at pharmacy counter to get them to run both rx plan.if this is what actually is happening i am surprised because i was always told there was not coordination between tricare rx and pdp

 

[billyb]

In 47 years in this business I have never enrolled a Tricare for Life beneficiary in a MAPD.