How Tricare For Life Covers the Medicare Advantage Drug Gap

Tricare For Life does not cover the Medicare Advantage drug gap, but it may reduce what you pay in other ways

Tricare For Life (TFL) is a secondary insurance program for military retirees and their families who are also enrolled in Medicare. When you have both TFL and Medicare Advantage, TFL does not step in to pay the coverage gap — the period when you pay the full cost of prescription drugs after your plan's initial coverage ends and before catastrophic coverage begins. However, TFL does cover some drug costs that Medicare Advantage does not, and it may lower your out-of-pocket costs through other mechanisms.

The key distinction is this: TFL acts as a secondary payer to Medicare, meaning it pays after Medicare has paid its share. With Medicare Advantage, the drug benefit structure is different from Original Medicare, and TFL's secondary role does not extend to filling the Advantage plan's coverage gap. If you want gap coverage, you would need to purchase a separate prescription drug plan or choose Original Medicare with a Medigap policy that includes drug coverage.

Key Takeaways

Tricare For Life does not pay the Medicare Advantage drug gap, which is the period when you pay full price for medications after initial coverage ends.
TFL may cover certain drugs that Medicare Advantage excludes or covers at a higher cost, reducing your total out-of-pocket spending.
If you want gap coverage, you can switch to Original Medicare with a Medigap plan that includes drug benefits, or stay with Advantage and purchase a standalone prescription drug plan.
Your actual costs depend on which drugs you take, which Medicare Advantage plan you chose, and whether TFL covers those same drugs.

How Tricare For Life works as a secondary payer

Tricare For Life pays second, after Medicare has processed a claim. This means Medicare Advantage determines what it will cover and what you owe, and then TFL looks at the remaining balance. If TFL covers the service or drug, it may pay part or all of what Medicare Advantage did not pay. If TFL does not cover it, you remain responsible.

With Medicare Advantage drug plans, the coverage gap is a built-in feature of the plan design. Once you and your plan have spent a certain amount on covered drugs (the threshold varies by plan and year), you enter the gap. During the gap, you pay the full retail price of drugs until your out-of-pocket spending reaches the catastrophic threshold. Because this gap is part of the Advantage plan's structure, TFL does not override it — TFL straightforward cannot pay for costs that fall into a coverage category it does not cover as a secondary payer.

What Tricare For Life actually covers for prescriptions

Tricare For Life covers prescription drugs that are on the Tricare formulary — the official list of covered medications. This formulary is separate from your Medicare Advantage plan's formulary. If a drug is on both lists, TFL pays second. If a drug is on the TFL formulary but not on your Advantage plan's formulary, TFL may cover it, though you would need to confirm this with Tricare.

TFL typically covers generic drugs, brand-name drugs with generic alternatives, and some brand-name drugs without generic equivalents. The copay or coinsurance you pay depends on which tier the drug falls into on the Tricare formulary. Because TFL is secondary, you would first pay what Medicare Advantage requires, and then TFL would explore its own cost-sharing rules to any remaining balance.

One practical scenario: if your Medicare Advantage plan does not cover a particular drug at all, but Tricare For Life does, you may be able to obtain that drug through Tricare and pay TFL's copay instead of the full retail price. This is not gap coverage, but it can reduce your costs for drugs your Advantage plan excludes.

Comparing your options if the drug gap concerns you

If you are worried about hitting the Medicare Advantage drug gap and want coverage during that period, you have three main paths:

Stay with Medicare Advantage and add a standalone prescription drug plan (PDP). Some people with Medicare Advantage also enroll in a separate PDP. However, this is unusual and may not be permitted depending on your plan and state. Check with your Advantage plan first.
Switch to Original Medicare and add a Medigap plan with drug coverage. Medigap Plan G, Plan N, and a few others include some prescription drug coverage. This is not the same as a standalone PDP, but it may help. You would also need to enroll in a standalone PDP (Part D) for more comprehensive drug coverage.
Stay with Medicare Advantage and budget for the gap. If your medications are common and inexpensive, you may never hit the gap. If you do, you pay full price temporarily. Some people find this acceptable, especially if their Advantage plan's premiums and in-network benefits are otherwise favorable.

Tricare For Life does not change these options — it remains secondary to whichever Medicare plan you choose. The decision between Advantage and Original Medicare should be based on your doctors, hospitals, prescription drugs, and total out-of-pocket costs, not on TFL's role.

How to find out what your actual costs will be

The only way to know whether the drug gap will affect you is to check your specific medications against your specific Medicare Advantage plan's formulary and cost-sharing structure. Medicare.gov has a tool called "Plan Finder" that lets you enter your drugs and see which plans cover them and at what cost.

Once you know your Advantage plan's costs, you can then check whether Tricare For Life covers those same drugs and at what copay. Contact Tricare directly (by phone at 1-800-538-9552 or through your regional Tricare office) with your drug list and ask which ones are on the TFL formulary and what your cost-sharing would be. This gives you a complete picture of your out-of-pocket exposure.

If you are considering switching to Original Medicare, use the same Plan Finder tool to see the costs of a Medigap plan plus a standalone PDP. Compare the total premiums, deductibles, and copays across all three scenarios — Advantage alone, Advantage with TFL, and Original Medicare with Medigap and PDP — to see which costs the least for your situation.

Common mistakes to avoid

One frequent misunderstanding is assuming that Tricare For Life will cover the Medicare Advantage drug gap because TFL covers so many other costs. TFL does reduce out-of-pocket spending for many services, but the drug gap is a specific coverage limit built into Advantage plans, and TFL does not override it.

Another mistake is not checking the Tricare formulary before enrolling in a Medicare Advantage plan. If you take a drug that is on the Advantage formulary but not on the TFL formulary, you may end up paying more than you expected. Conversely, if a drug is on the TFL formulary but not on your Advantage plan's formulary, you might have an option to use Tricare instead — but you need to know this before you enroll.

A third mistake is waiting until you hit the drug gap to think about this. If you know you take expensive medications, research your coverage options before the calendar year starts. Open enrollment for Medicare runs from October 15 to December 7 each year, and you can change plans during this window.

Frequently Asked Questions

If I have Tricare For Life and Medicare Advantage, who pays first for my prescriptions?

Medicare Advantage pays first. It applies its formulary, copays, and coverage rules. Tricare For Life then pays second, on any remaining balance, if the drug is on the TFL formulary. You pay whatever both plans do not cover.

Can I use Tricare to fill a prescription my Medicare Advantage plan won't cover?

Possibly, if the drug is on the Tricare formulary. Contact Tricare to confirm. If TFL covers it, you would pay TFL's copay instead of the full retail price. This is not a may provide — some drugs may not be available through Tricare even if they are on the formulary.

Does switching to Original Medicare and Medigap eliminate the drug gap?

No. The drug gap is a feature of Part D (standalone prescription drug plans), not of Original Medicare or Medigap. If you enroll in Original Medicare and a PDP, you will still encounter a drug gap. However, some Medigap plans include limited drug coverage that may reduce your costs.

What should I do if I cannot afford my medications during the Medicare Advantage drug gap?

Ask your doctor about generic alternatives or lower-cost drugs on your plan's formulary. Some drug manufacturers offer patient information programs for people who cannot pay. You can also contact your state's pharmaceutical information program or a local community health center for resources.

Can I have both a Medicare Advantage plan and a standalone prescription drug plan?

Generally, no. If you are enrolled in a Medicare Advantage plan that includes drug coverage, you cannot also enroll in a standalone PDP. If your Advantage plan does not include drug coverage, you can enroll in a PDP. Check with your specific plan to confirm.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.