But that's why you are here, no? It doesn't mean the code is uncrackable. Let us start with the basics shall we? If you have approached turning age 65 and are currently a Tricare beneficiary, you should already know that Medicare is an important part of your Tricare once you reach that golden age of 65. It is not uncommon for Tricare to send out a letter to its members when they are approaching their 65th birthday, informing them that they would like them to enroll into Medicare, and if they do not do so, they could be in danger of losing their Tricare benefits. Yeah. That is a real thing. Tricare backs up Medicare as a secondary insurance in the role of Tricare for Life once you reach age 65. Medicare that is provided by the government in the form of Medicare Parts A (Hospital) and B (Medical) can best be looked at as two pieces of a puzzle that fit together to give you medical coverage. They pay typically 80% of your medical expenses while Tricare covers the remaining 20%. Between the two, you shouldn't have any medical out of pocket, plus Tricare covers your medications as well as you can normally ask for. Sounds perfect right? For most, it is. It's true. You are in great shape having Tricare as a secondary to pair alongside Medicare. You definitely won't lose any sleep at night. However, most people on Tricare do not realize they have another option available on how one would set up this combination. No , I am not talking about getting rid of Tricare, or trying to replace your Tricare. That would make no sense! I am talking about adding to it. You can do so by picking up a Medicare Advantage plan. Have you ever caught those cheesy Joe Namath ads popping up all over your television screen? Or how about all of those commercials pitching $0 premium plans? Yep. Those are all ads for Medicare Advantage plans. I know I know, it's typically people's first reaction to flip the channel anytime Broadway Joe comes on the screen. But if done correctly, a Medicare Advantage plan can work as a true asset for a Medicare and Tricare beneficiary.
First, one must understand one simple, but very important question: What is a Medicare Advantage plan anyway? Medicare Advantage can best explained as a program to where a person on Medicare will run their Medicare through a private insurance company. This private insurance company then takes over as the primary insurance and Medicare itself no longer pays anything towards the person's claims. As one might imagine, this takes a large burden off of Medicare's back since they no longer have to pay those medical claims. In exchange, Medicare agrees to fund this private insurance company every month to compensate them for taking care of people's Medicare. Because of this funding, it is quite common for Medicare Advantage plans to have low costs to them, and in fact, there are many around our great country that cost nothing monthly. That is where the term $0 premium comes from. Of course, you still have to pay your Medicare Part-B premium and keep your Parts A & B active. However, the Advantage plan can come with no extra premium. Medicare Advantage plans will typically come with medical, prescription drug coverage, and sometimes even some extra perks like gym memberships, coverage for over the counter items, dental, vision, hearing, and much more. So what is the catch? The catch is that these programs come with networks of hospitals and doctors. This means that they work more like traditional insurance. If you go out of network, you either have no coverage, or decreased benefits in most cases. This is different than original Medicare from the government, as you are able to go to any doctor or hospital in the country as long as they accept Medicare assignment. Depending on your source, anywhere between 93%-98% of doctors accept Medicare assignment across the country. With Tricare for Life and Medicare working together, as long as Medicare pays first as the primary insurance, Tricare will pick up the difference. This causes the Medicare Advantage plan to be a negative in terms of that open network convenience. However, what are the positives of picking one of these up to work with your Tricare? How does it all work? Well, since a Medicare Advantage plan becomes the primary payee of claims, it pays first instead of Medicare. Then Tricare comes behind as a secondary. The one key is that in order for it to work like original Medicare does, the provider must be in your plan's network. So why purchase one of these plans to pair with your Tricare? I will be the first to tell you that these plans are not for everybody. Either way, you will have great coverage and will not lose sleep at night over how you are protected. The positives that come with going this way is all the extra perks that come with a Medicare Advantage. These plans are required to cover everything that original Medicare covers so you don't lose anything in terms of that. Here are the characteristics I believe you should look for in a Medicare Advantage plan if you have Tricare for Life: 1.) Zero premium: This should be obvious. Of course, zero premium plans aren't a fit for everybody, but when you have Tricare, you have great coverage already. There is truly no need to pay even $1 for anything extra. But if it comes at no cost, then it makes a little more sense. 2.) No prescription coverage: This is one of the only times I would recommend picking up a Medicare Advantage plan without prescription coverage. Why would you? Because you already have great prescription drug coverage with your Tricare. On top of that, you lose access to the mail order pharmacy they provide (which gives significant discounts). The reason for that is that they cannot send meds through the mail as a secondary insurance. It is better to leave off the drug coverage, and trust me there are plans that exist that do not come with drug coverage. 3.) Part-B giveback: If it is available in your area, plans that have a benefit called a Part-B giveback can be a nice incentive! As I mentioned throughout this article, YOU STILL MUST PAY YOUR MEDICARE PART-B PREMIUM. In 2021 at the time of writing this, that premium is $148.50 per month (unless you are in a higher tax bracket). Plans exist all over the country that will lower the amount you pay for your Part-B premium. It could be $20 per month, $30 per month, r maybe even $80-$100 per month, depending on where you live and what is available. This is a nice perk when you have Tricare! 4.) Make sure your plan has a large and wide provider network. Make sure all of your doctors are covered. When you follow these tips step by step, you get all the same benefits of Medicare and Tricare, but get some extras in the process. Working with a licensed insurance agent never hurts anything either!
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Most people know what a Medicare Supplement is. If for some reason you don't, they aren't to difficult to explain! Medicare supplement plans, or Medigap plans, are plans that are purchased through a private insurance company to pay the 20% that Medicare leaves behind. Medicare supplement plans are standardized, meaning that the plans are designed by the government and then given to private insurance companies to market. This means, essentially, that all of the insurance companies that offer these programs offer the exact same plans, just for different prices. The only other difference between one carrier and another, typically, is the company's long-term rate increases. You see, typically Medicare Supplement companies raise their rates every year as you get older. They do this for many reasons, which is such a long explanation it will have to wait for a future article. Some great ways to spot an insurance company that raises rates 15% per year opposed to one that only raises 5% a year can be tricky for a consumer. Here are a few ways you can do just that! 1.) Big names: Make sure you are working with a name you recognize. Usually the big companies (or the blue chips as I like to call them) are the companies that are best equipped to keep a price consistent. If a company has a smaller, unknown name, that usually means you are not the only person who is not familiar with them. They may be good some day, but do you really want to go through growing pains with your insurance company? 2.) Rate increase history: Ask your broker to show you the company's rate increase history for the last 5+ years. History is a great indication for what the future should hold (roughly) in terms of what to expect. If the broker or agent cannot provide these numbers, get a new broker or agent! 3.) Make sure you are enrolling into plans that are long-term and not short-term. For example, Plan F has stopped taking customers with all carriers that are newly eligible to Medicare starting 01/01/2020. This means without new customers coming in, and the existing customers aging, the prices are expected to shoot up with a majority of Plan F companies. Here is a video I made all about it! Christian BrindleFounder & President of Christian Brindle Insurance Services. Host of "The Everything Medicare Podcast!". Author of the books "The Insurance Funnel" & "Medicare Guidance: Picking the Plan for You.". There is an interesting time that very few people talk about in terms of retirement. People discuss what age they should draw social security, what age they should retire, when to cash out on their 401k. What you don't hear as much emphases on is getting onto Medicare. When someone turns 64, they usually don't know anything about Medicare. All they know is that they have been paying into it throughout their life and that it is something they will have to deal within a year when they turn 65 years old. That's about it. What starts to get their attention is when they begin to become bombarded with mailers, phone calls from solicitors, television commercials, and even strangers knocking on their doors, all wanting to talk to them about Medicare. Vultures! Once this person starts to look into it for themselves with a simple Google search, chances are, they end up more confused then they were before. They stumble upon things like Medicare Parts A, B, C, D, etc. What does this all mean? Why do they make it so confusing!? My simple answer to this, is it's the government! It's what they do best, is it not? I am going to take 80% of the confusion out of the equation right here and right now. The only two parts of Medicare that come from the government are Medicare Parts A & B. A covers the hospital, skilled nursing facilities, and hospice care. Part B covers doctors fees, out patient care, durable medical equipment, among other things. In short, A & B cover medical bills. Meaning they do not cover things like prescriptions, dental, vision, or hearing. Medicare only covers 80% of medical bills, leaving 20% behind for the consumer to pick up. There are really only two ways a person on Medicare can go when they are going about enrolling. They can go with a traditional Medicare Supplement plan (A.K.A Medigap) to pay the 20% of medical bills that Medicare does not pay for and pair that with a Part-D drug plan to cover medications. The other alternative is they can go with what's known as a Medicare Advantage plan (also known as Part-C), which works in some ways, as a private insurance company stepping in and your Medicare is ran through that company. These are all the ads you see for the $0 premium plans on television as well as the ads for "free" dental, vision, and hearing coverage. These plans are federally funded so they typically come with very low premiums, if any at all, and they typically increase your medical coverage, provide you with drug coverage, and can come with dental, vision, and hearing coverage (although some plans have more than others). Both sides have their ups and downs, but everything you ever have heard about Medicare, or ever will hear, falls into one of those two categories. Focus on understanding these two options and the good and bad to them, and it will simplify your process tremendously! Christian BrindleFounder & President of Christian Brindle Insurance Services. Host of "The Everything Medicare Podcast!". Author of the books "The Insurance Funnel" & "Medicare Guidance: Picking the Plan for You.". I have spent my entire adult life working with people on Medicare. I have seen a lot. I have seen people handle the whole process perfectly, and I have seen plenty handle it terribly. I don't blame anybody for feeling overwhelmed. I mean, the process seniors have to go through is ridiculous. From the stacks of mailers that offer little assistance, to the harassment from cold callers, to strangers even showing up at their door uninvited and unannounced. Its enough to make anybody go crazy. Because of all the pressure put on seniors to make a quick decision its understandable to make some mistakes. Quick and rushed decisions don't typically turn out to well, and Medicare plan selection is no different. The sad part of this is that it is possibly the single most important things for seniors to get right. These are the three biggest mistakes I have seen seniors make when they are approaching their 65th birthday: 1. Picking a plan just because a loved one has it.A simple thought many seniors have is, "My neighbor has this plan, so it must be great!". It might be great for your neighbor, but that doesn't mean it will be good for you. Medicare is not a one size fits all glove that can be warn. With Medicare, there are choices that exist such as whether someone needs a Medicare Supplement or a Medicare Advantage plan. Both sides have tremendous pros and cons that come along with them. There are a lot of working parts between prescription coverage, to medical coverage, to dental vision and hearing benefits, to provider networks. No two people are exactly the same. Its best for a person to pick a plan specifically based on their needs and preferences, not a plan that was picked for a loved ones needs and preferences. 2. Waiting until the last minute to enroll.I could make an entire article on this alone, but I will condense this issue down for the sake of the article. One important factor when it comes to Medicare, is the time periods one must follow on when you can enroll. When a person turns 65 years old, as long as they meet the qualifications of Medicare (40 quarters of working in the country, and being a US citizen) they will be given an open window for which they can make their preparations for their Medicare. This window is a total of 7 months. 3 months before the month a person turns 65, the month a person turns 65, and 3 months after the month they turn 65. Medicare always starts on the 1st of someones birth month (unless their birthday falls on the first, to which it will begin a month sooner). Medicare is designed and intended to begin on the 1st of your birth month. Having it start any other day comes with some extra hoops to jump through. Unfortunately, Social Security is the department that is charge of processing enrollments into Medicare. We all know how unorganized Social Security can be. I always recommend to my clients to begin the process 90 days out from the month they turn 65. Its better to give it more time instead of less. 3. Calling a 1-800 number on a TV commercial.Joe Namath wants you to call him! Haven't you seen the commercial? Millions of people every year are thrust into a terrible situation by doing such action. Calling large call centers with paid celebrity sponsors is a mistake for two reasons: 1.) You have no individual agent to take care of you. The agents on the phone are simply order takers. 2.) It is common they are not detailed in checking the best fit for you. This one is pretty simple. The agent on the phone, will likely never be able to be reached by you again when you have issues. The great thing about having an independent agent by your side is that you can call them for assistance if you have a question or have a billing issue. The best part is, they don't cost a dime. The exact same price as going directly through the insurance company. A good agent can change your life for the better. You are giving that up when you call Joe, or any other 1-800 number likely. Christian BrindleFounder & President of Christian Brindle Insurance Services. Host of "The Everything Medicare Podcast!". Author of the books "The Insurance Funnel" & "Medicare Guidance: Picking the Plan for You.". Many things are being discussed during the coronavirus pandemic. Unemployment is at an all time high. Many people are not leaving their homes for fear of coming in contact with and contracting the virus. At the time of this publication, the United States has a little over 492,000 cases, with north of 18,000 confirmed deaths as a result of the outbreak. There is no doubt that with bills to pay, unemployment is a real problem for many Americans. An issue that is getting far less attention however, is having good health insurance coverage. Whether you are on Medicare, ObamaCare, group health insurance, or something else, there has never been a more vital time to not only be covered, but to be covered well. With many health insurance companies coming out and stating that they will be picking up the bill for all COVID-19 treatment for their members, the time is now to make sure your options are in place. I started in the Medicare world as a licensed health insurance agent in 2014. I have seen many situations with clients of mine as my company continues to work with more people as the years pass by. Never before have I seen a time where it is more vital to have good coverage! It's always been important, but right now it is crucial. In the US today, a one night stay in the hospital can run you upwards of $5,000, depending on what you are being seeing you for. What we do know about this virus is that it is highly contagious, and depending on a number of factors such as your current health, your age, and just how your body responds to the illness, you could require medical treatment to help beat the illness. It's not just about making sure you have the health insurance (even though studies show that still almost 10% of the population goes without coverage!); it's also about making sure you are on the best plan you can be... one that fits your needs and preferences specifically. I've made it my mission in life to solve this problem for as many people as I possibly can. I hope and pray you are taking seriously the need to be fully covered during this crisis. Insurance is always something you want to have in case you need it, but pray you never have to use it. There is a good chance that if you fall victim to this outbreak, you may need it more than you think! Christian BrindleFounder & President of Christian Brindle Insurance Services. Host of "The Everything Medicare Podcast!". Author of the books "The Insurance Funnel" & "Medicare Guidance: Picking the Plan for You.". |
AuthorI have worked with people on Medicare my entire adult life. You probably don't have to wonder how exciting my life is! Over the years, I have helped countless individuals figure out this extra complex world of Medicare as they age into retirement. Archives
February 2021
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