Using Other Insurance
When you have other health insuranceAny health insurance that you have in addition to TRICARE such as Medicare or employer-sponsored health insurance. TRICARE Supplements are not considered "other health insurance." with pharmacy benefits, your other health insurance is the first payer and TRICARE pays second. To avoid higher costs, you can get prescriptions filled at a TRICARE network pharmacy that is also in your other plan's network.
TRICARE Pharmacy Home Delivery
You can’t use the Home Delivery option when you have other health insurance, unless:
- your other plan doesn’t include pharmacy benefits,
- the drug you need isn’t covered by your other plan, or
- you’ve met the other plan’s benefit cap
If you’ve met one or more of these requirements, you can send your prescription to be filled through Home Delivery. You'll need to send proof from your other plan that it's not covered or you've met the benefit cap.
TRICARE Network Pharmacies
Having other health insurance doesn’t prevent you from using a TRICARE retail network pharmacy. Your other plan pays first and TRICARE pays second.
Online Coordination of Benefits
When you fill prescriptions at a network pharmacy, tell your pharmacist you also have TRICARE. Your pharmacist will submit your prescription online to both plans at the same time.
When you process your pharmacy claims online:
- Minimal out-of-pocket expenses
- Never pay more than the TRICARE copayment
- No need to submit paper claims
- Reduced or eliminated up-front costs
TRICARE becomes the first payer when:
- The drug is not covered by your other plan, but is covered by TRICARE.
- Coverage under your other plan is exhausted for the benefit year.
If you're using a mail order program through your other plan, online coordination of benefits is not an option.
To be reimbursed for the eligible portion of your out-of-pocket expenses, you must file a prescription claim.
Keep your receipts!
Once you’ve exceeded the dollar limit for your other health insurance (OHI) or if the drug isn’t covered by your OHI, you can file a claim with TRICARE for reimbursement.