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!
10/7/2021 10:12:43 pm
Very interesting and thanks for sharing such a good blog. Your article is so convincing that I never stop myself from saying something about it. You’re doing a great job. Keep it up.
11/13/2021 08:27:57 am
Other consideration is while doctors may be included in plan this year, what happens next year if provider can't negotiate with doctors and doctors become out-of-network? And what are difficulties of returning to original medicare if I decide not to stay in advantage plan?
1/13/2022 02:25:33 pm
Not all Medicare Advantage plans (MA) coordinate with Tricare For Life (TFL). Yes, TFL will pick up the copays on the MA plan. The issue is that there is inconsistency in whether the balance of the MA plan claim (deductible, copay. and/or coinsurance) will be automatically crossed over to TFL for processing and reimbursement. In many cases, after the MA plan processes the claim, the beneficiary will have to file a paper claim (many providers will not file these paper claims) with the TRICARE for Life.
9/1/2022 04:23:13 am
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I 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.