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Question from Kevin: I’m 65 and on Medicare with TRICARE for Life as my Supplement. I’m looking for an additional no cost Medicare Advantage Plan that will provide for Silver Sneakers or some type of fitness plan, and possibly other benefits I don’t currently receive. Do you have any suggestions or recommendations?
For those who are unaware, TRICARE for Life is a no-cost Medicare Supplement that Veterans and their spouses qualify for based on certain criteria such as, but not limited to, those who received the Medal of Honor or served 20 or more years in the military. It’s well deserved and provides outstanding coverage. Those who have it don’t need to purchase a Medicare Supplement, Part D prescription plan, or an Advantage Plan because there are no co-pays for Medicare covered services with TRICARE for LIFE. Those on TRICARE for Life, as with others on Supplements, can utilize virtually every doctor and hospital in the country.
Prescription drug coverage is also included and co-pays for medications are very similar to both stand-alone Part D and Advantage Plan drug coverage. However, as Kevin’s questions indicate, Advantage Plans offer benefits not included in either his TRICARE or other Federally regulated Supplements (Medigap) plans. Most Medicare Advantage Plans have several ancillary benefits. All offer Silver Sneakers, a free gym membership. Most also provide some benefits for a free routine eye exam and a semi- annual or annual allowance for eyeglasses between $100 and $250. Others may also provide dental coverage that may be limited to preventative services like cleanings and X-Rays only or be more comprehensive and include coverage for services such as fillings, crowns, root canals, and dentures. Please be advised, what’s covered varies from company to company and plan to plan.
A newer benefit some plans offer is an Over the Counter allowance that can be as much as $500 per year. Those who have it can order products from a catalog that can generally be found on the shelf at most pharmacies. Items include mosquito repellant (no kidding) to vitamins to pain medications and cold remedies to ankle and knee braces, among many others. Orders are made over the phone or online and are then mailed to a beneficiary’s home at no cost.
Those who have TRICARE for Life can indeed enroll in a Medicare Advantage Plan HMO or PPO if they so choose and receive some or all of these ancillary benefits. However, it changes who becomes the primary insurer and how claims are paid. TRICARE for LIFE and other Supplements are set up to pay secondary to Medicare. In other words, cover the gaps that Medicare doesn’t pay, namely the $1,408 Part A Hospital deductible and the 20% of Part B outpatient services. When you have TRICARE or another private Federally regulated Supplement plan, such as C, G, F, or N, Medicare pays their portion of the claim and communicates with the supplement provider regarding how much they owe and who they owe it to. The medical provider is then made whole between the two reimbursements.
That changes when someone on TRICARE for Life opts to enroll in an Advantage Plan. What happens at that point is the Advantage Plan becomes primary and TRICARE for Life Secondary. Medicare is no longer responsible to pay claims. Medicare Advantage Plans were not created to communicate with a secondary insurance like Medicare does. In no way is that a knock on Advantage Plans. It’s simply not a function of them nor should it be in my opinion for reasons I won’t go into in today’s column. You can read about these nuances in past columns or listen to one of my recent podcasts for more details.
Therefore, if you had TRICARE for Life and an Advantage Plan, you would need to pay all charges associated with the HMO or PPO up front and then submit your own claims to TRICARE by mail in order to get reimbursed, a process some may not want to deal with. One other note of importance. Since the Advantage Plan would become primary, those on TRICARE for Life would be subject to the Advantage plan’s network of doctors and hospitals and would not have the same nationwide coverage if Medicare was primary. That may not be a huge issue for some folks who don’t travel much or wouldn’t be concerned about having access to out of state hospitals. However, some people find it important to not only have access to our outstanding Pittsburgh area health systems, but the freedom to utilize other world class hospitals such as the Cleveland Clinic, Mayo Clinic, MD Anderson Cancer Center, and others if necessary.
The agents at The Health Insurance Store would be honored to help any Veteran or TRICARE for Life recipient go over Advantage Plan options and explain the dynamic of having both plans and making a choice in HMO or PPO. However, as always, it’s important you understand the pros and cons of doing so.That goes for anyone who will be enrolling in Medicare soon and needs to decide between a Supplement or Advantage Plan.
If you would like to make an appointment for a no cost consultation, please give us a call or visit our website, where you can also find archived columns and our new weekly podcasts where we get more in depth on column topics and other important issues in the healthcare and insurance industry. And please keep the great questions coming. Send them to me personally at aaron@ getyourbestplan.com.
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