Tricare For Life does not fill the Medicare Advantage drug coverage gap

Tricare For Life is a secondary insurance for military retirees and their families who are also enrolled in Medicare Parts A and B. It pays some of the costs that Medicare does not cover — but it does not pay the prescription drug gap that appears in Medicare Advantage plans.

The gap (called the "donut hole") occurs after you and your plan together spend $5,380 on covered drugs in 2024. Once you enter the gap, you pay a larger share of the cost until your out-of-pocket spending reaches $7,050. Tricare For Life does not step in during this period. You are responsible for those costs, though some Medicare Advantage plans offer gap coverage as an extra benefit — Tricare For Life does not change that.

If you have both Tricare For Life and a Medicare Advantage plan with prescription drug coverage, Tricare For Life will cover some of your other medical costs during the gap period, but not the drugs themselves.

Key Takeaways

  • Tricare For Life covers some Medicare copays and coinsurance but does not pay for prescriptions in the Medicare Advantage drug gap.
  • The drug gap begins after combined spending on covered drugs reaches $5,380 and ends when your out-of-pocket costs hit $7,050 (amounts vary yearly).
  • Some Medicare Advantage plans offer their own gap coverage as an added benefit, separate from Tricare For Life.
  • If you want drug coverage throughout the year with no gap, you may want to compare Medigap Plan G or Plan N alongside your current Tricare For Life coverage.

What Tricare For Life actually covers

Tricare For Life acts as a secondary payer after Medicare. This means Medicare processes your claim first, and then Tricare For Life pays a portion of what Medicare does not cover. It typically covers Medicare copayments, coinsurance, and deductibles for hospital stays, doctor visits, and other medical services.

Tricare For Life does not cover prescription drugs at all — whether you are in the gap or not. Drug coverage comes only from your Medicare Part D plan (if you have Original Medicare) or from your Medicare Advantage plan's drug benefit. Tricare For Life's role is limited to the medical side of your care.

How the Medicare Advantage drug gap works

When you enroll in a Medicare Advantage plan that includes prescription drug coverage, the plan tracks your spending on covered drugs throughout the year. The amounts that count toward the gap are the actual cost of the drug, not just your copay. Once the total reaches $5,380 in 2024, you enter the gap.

In the gap, you typically pay 25% of the cost of brand-name drugs and 25% of the cost of generic drugs until your out-of-pocket spending reaches $7,050. At that point, you move into catastrophic coverage, where you pay a small copay or coinsurance for the rest of the year. Tricare For Life does not reduce any of these gap-period costs.

Some Medicare Advantage plans do offer gap coverage as an extra benefit — meaning the plan itself will pay part or all of your drug costs during the gap. This is a plan feature, not something Tricare For Life provides. You would need to check your specific plan's summary of benefits to see if gap coverage is included.

Comparing your options if the gap is a concern

If you have Tricare For Life and are worried about the drug gap, you have a few paths to consider. The first is to review your current Medicare Advantage plan's benefits to see whether it includes gap coverage. Many plans do not, but some do — and the only way to know is to check your plan's official documents or call the plan directly.

The second option is to switch to Original Medicare with a Medigap plan and a separate Medicare Part D drug plan. Some Medigap plans (such as Plan G or Plan N) cover some of your Medicare copays and coinsurance, much like Tricare For Life does. You would then enroll in a standalone Part D plan for drug coverage. Part D plans also have a gap, but some people find the combination of Medigap and Part D more predictable than Medicare Advantage.

A third option is to stay with your Medicare Advantage plan and budget for the gap period, or to work with your doctor to use generic drugs when possible, which may lower your total spending and delay when you enter the gap.

When to contact your plan or Tricare For Life

If you are unsure whether your Medicare Advantage plan includes gap coverage, contact the plan directly — the customer service number is on your insurance card. Ask specifically whether the plan covers any costs during the prescription drug gap. The answer will be yes, no, or a partial amount.

If you have questions about what Tricare For Life covers, you can reach Tricare at 1-800-538-9552 or visit the official Tricare website. They can confirm that Tricare For Life does not cover the drug gap and can explain what other costs Tricare For Life will cover during that period.

Frequently Asked Questions

Does Tricare For Life cover any prescription drugs?

No. Tricare For Life does not cover prescription drugs under any circumstances. Drug coverage comes only from your Medicare Part D plan (if you have Original Medicare) or your Medicare Advantage plan's drug benefit. Tricare For Life covers medical services like hospital stays and doctor visits.

If I have Tricare For Life, do I still need to enroll in a Medicare Advantage drug plan?

Yes. Tricare For Life does not provide drug coverage, so you need either a Medicare Advantage plan with drug coverage or a separate Medicare Part D plan. If you do not enroll in drug coverage when you first become may be able to access, you may face a late enrollment penalty.

Can I use Tricare For Life to pay my copay during the drug gap?

No. Tricare For Life does not pay for prescription drugs or drug-related costs, including copays during the gap. Your Medicare Advantage plan or Part D plan is responsible for those costs, and Tricare For Life will not step in.

What should I do if the drug gap will cost me a lot of money?

Talk to your doctor about generic alternatives, which typically cost less and may help you avoid or delay entering the gap. You can also review your plan's benefits to see if it includes gap coverage. If you are considering switching plans, the annual open enrollment period (October 15 to December 7) is when you can make changes.