Q: What do I need to do if I am enrolled in Medicare Part D (or if a beneficiary under my coverage is enrolled in Medicare Part D)?
A: If current Medicare Part D coverage exists, all claims must be processed through the Medicare Part D insurance first and then processed to TRICARE as secondary.
When you fill a prescription at a retail pharmacy, ask the pharmacist about online Coordination of Benefits with TRICARE. This allows the pharmacy to submit the claim electronically to Express Scripts, permitting access to any TRICARE reimbursement instantaneously while bypassing the need to submit a DD2642 claim form.
Q: How can I be reimbursed if a pharmacist cannot electronically coordinate my Medicare Part D benefits with TRICARE?
A: You may file a paper claim by sending a completed DD2642, a Medicare Part D Explanation of Benefits and electronically generated pharmacy receipts to:
Express Scripts
Attn: TRICARE Claims
P.O. Box 66518
St. Louis, MO 63166-6518
Any beneficiary enrolled in Medicare Part D with claim activity in their Medicare Part D Prescription Drug Plan (PDP) automatically receives a monthly Explanation of Benefits from their PDP.
Q: If I choose (or if a beneficiary under my coverage chooses) to disenroll from Medicare, should I (or the beneficiary) disenroll from Medicare Part B, too?Important Note: All manual claim submissions must include a Medicare Part D Explanation of Benefits, provided by the Medicare Part D plan. Claims received without the Part D Explanation of Benefits are returned to the beneficiary for the missing information and resubmission.
A: No, Medicare Part B is required for the TRICARE benefit if the beneficiary is over the age of 65.
Important Note: If you have recently disenrolled from Medicare Part D, you should send a copy of the disenrollment paperwork, showing the effective date and end date of Medicare Part D coverage to DEERS (Defense Enrollment Eligibility Reporting System), via mail or fax. All information sent to DEERS must include the Sponsor’s Social Security Number.
Mail to:
DSO
400 Gigling Road
Seaside, California 93955-6771Or
Fax to:
1-831-655-8317
Learn More
For more information about TRICARE and Medicare Part D, please visit the Medicare Part D Frequently Asked Questions on the TRICARE website.