Officials explain Tricare vaccine coverage

FALLS CHURCH, Va. (AFRNS) -- One of the most valuable benefits of Tricare is free or low-cost health care; however, beneficiaries must understand co-payments, deductibles and how Medicare works with Tricare to make the most of the health benefit. This will help avoid unexpected charges and denied claims, according to Tricare officials.

For example, a 69-year-old retired Navy chief warrant officer learns of a new vaccine covered as a Tricare medical benefit so he immediately takes advantage of it. A few weeks later, the chief warrant officer is surprised to see a bill for more than $100. Now faced with paying an unexpected medical expense, he learns that a covered benefit does not always mean free.

Just like the Tricare benefit, Medicare has medical and prescription coverage. As a Tricare-for-Life beneficiary, it is important to know what Medicare covers and what Tricare covers.

Many vaccines are a service that may be covered by Medicare only as part of its prescription drug program (Medicare Part D), while being covered only as a Tricare medical benefit. One such example is the Zostavax vaccine for shingles. Tricare will reimburse a medical provider for administering the Zostavax vaccine in their office as a part of the Tricare medical benefit. It is important to realize vaccines are not a part of the Tricare pharmacy benefit because they can not be self-administered by the patient. In these cases where it is not a medical benefit under Medicare, the only way to avoid paying the Tricare deductible and cost shares is to have both Medicare Part D and Tricare. Since many Tricare-for-Life members do not have Medicare Part D because of their Tricare pharmacy benefit, they are responsible for a cost share.

For more information on Tricare-for-Life benefits, co-payments, and claims, visit or contact WPS Tricare-for-Life at (866) 773-0404. (Courtesy of Tricare)