Coverage of the shingles shot under TRICARE For Life (TFL) is a common question among retirees. It’s an issue we have been working on, but don’t get your hopes up.
Medicare covers the shingles shot as a pharmacy issue under Part D insurance. Most military retirees have no Part D coverage because of our TRICARE pharmacy plan. Having another pharmacy program disqualifies us from the TRICARE home delivery program and can cause us to file manual claims to TRICARE pharmacy for reimbursement.
[TAKE ACTION: Tell Congress to Control TRICARE Copays]
TFL covers the shingles shot as a medical coverage, not pharmacy coverage. So, the process goes like this:
- You get the shingles shot.
- You do not have Part D Medicare, so the cost falls to TFL.
- TFL covers the shot as a medical cost not covered by Medicare.
- When medical costs are not covered by Medicare, TFL deductibles and cost-shares apply.
- The deductible is $150 single/$300 family rates, with a $30 cost share for a network primary care doctor.
The bottom line is, you pay for the shot even though it is technically covered.
That explains the medical coverage-side of TFL, however, on the pharmacy side of TFL, you can get the shot at a Tricare network pharmacy. Use the Tricare pharmacy coverage and the shot is covered. Yes, it is confusing.
[RELATED: More Health Care News from MOAA]
There is confusion about the shot coverage because the TRICARE Prime and Select programs cover the cost of the shot if it's administered by your network doctor. TRICARE Prime and Select are major medical plans, and TFL is a Medicare supplement plan. Major medical plans and supplement plans are apples and oranges, and comparisons do not apply.
If you are a Prime or Select enrollee and meet the TRICARE requirements for the shingles shot, you may want to get the shot before transitioning to Medicare/TFL at age 65.