Tricare For Life Medicare Part B – Over the years, I’ve often been asked to make a video and write a blog post about how Medicare works with Tricare for Life. I was hesitant to do this because TRICARE for Life is a government program. Insurance agents are not authorized to sell TRICARE life insurance. I can only give my opinion as a licensed agent with over three decades of experience in financial services. I am not a TRICARE for Life agent.

While I can’t help you directly with TRICARE or ChampVA, I can help you understand how TRICARE for Life works with Medicare or ChampVA and how to avoid a potentially serious mistake. Oh. That’s what I’m going to do here.

Tricare For Life Medicare Part B

In recent years, there has been an insurance company that has decided to sell directly to our military veterans. Marketing directly to veterans and their families, the insurance company has developed several training materials to help individual agents understand the product and market.

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Unfortunately, they are fighting an uphill battle. In some cases, it’s simply a matter of agents not reading or viewing the content provided to them. In other respects, it is a battle against greed. This is a war against people who are hungry for profit and put their commission before your health.

This is a serious pet peeve of mine and recent conversations with other Medicare agents have given me all the motivation to write this post today. My parents had TRICARE for life coverage. My father was a career Marine. He and my mother died and are buried together in Arlington National Cemetery. Both of their end-of-life circumstances were medically involved. In both cases, their end-of-life care is easier because they have TRICARE for Life, not a Medicare Advantage plan.

I will give you a short answer here and then follow it up with a more detailed and important explanation.

If you have TRICARE for Life or ChampVA, it is my opinion, and the insurance company I indicated, that you keep your TRICARE or ChampVA and keep Original Medicare. Don’t switch your Medicare for a Medicare Advantage plan, exchange your TRICARE or ChampVA for Medicare Supplement, and don’t get a stand-alone Medicare Part D plan.

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I believe you cannot improve your health care by interfering with your TRICARE. If you replace your original Medicare with an Advantage plan, you are actually reducing your insurance coverage and increasing your financial risk.

For TRICARE for Life to be active, you must also have original Medicare. These are Medicare Part A (hospital care coverage) and Medicare Part B (outpatient coverage). Original Medicare becomes your primary insurer and there is a secondary TriCare, like a Medicare supplement plan. Tricare is free for life. You have accumulated.

The part of it that is most important and the reason I made this video is that real Medicare, the red, white and blue Medicare card is your primary insurance.

Why is it important to have Original Medicare as your primary insurance? Because you can keep your original medical benefits.

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First, with Original Medicare as your primary insurance, you’re not limited to one network. You can see any doctor or visit any medical facility in the country as long as they accept Original Medicare. This is almost every doctor and every medical facility in America. or territory of the United States. There are very few exceptions.

Second, no insurance company can interfere with your care. Your medical decisions are between you and your doctor. Both Medicare and TriCare aim to cover all medical needs. Your doctor does not need to get pre-approval from the insurance company. You do not need to get a referral from your doctor if you want to see a specialist. No insurance company can stop or withhold your treatment based on its internal rules. All medical decisions are between you and your doctor.

When you have Original Medicare, TRICARE for Life and Medicare cooperating, your annual maximum out-of-pocket financial risk is limited to almost zero. In fact, the only cost for inpatient or outpatient services is if TRICARE approves treatments that Medicare does not. I’ve never seen it happen, but I think it’s possible. In this case, TRICARE will cover the service on your behalf with a reduced capacity. Please see your TRICARE Benefit Statement online for details. I have the official website link below.

As I mentioned, TRICARE for Life is like a Medicare supplement plan on steroids. In addition to standard Medicare Supplement benefits, your TRICARE includes prescription drug coverage. You don’t want to get a separate Medicare Part D plan. In fact, it can hurt your TRICARE, especially ChampVA.

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By the way, did you know that your drug coverage through TRICARE is not subject to the costly coverage gap that characterizes Medicare prescription drug coverage? You don’t have a coverage gap, you don’t have a donut hole like Part Ds to deal with.

One of the best benefits I like about TRICARE is that it provides a wide range of health care overseas. Medicare only works in the US and US territories. Some Medicare supplement plans offer limited emergency coverage if you live abroad. When you have TRICARE Lifetime and you move or move abroad, TRICARE will be your primary health care coverage abroad. very cool

So what motivated me to make this video and what is my problem with some other Medicare agents or brokers?

Let’s start with the main question. Many Medicare-focused insurance agents struggle to make a living. Others do not take the time and effort to understand their insurance products before selling them.

How Medicare Works With Tricare For Life

Insurance agents do not and cannot sell Tricare. On the other hand, Medicare Advantage plans pay the highest commissions of any Medicare product. So when someone with TRICARE asks for help, instead of just telling them they’re on a good plan, some agents try to find a way to sell the good plan by pretending you have insurance. not you.

The only thing an insurance agent can do to improve your coverage is to offer you a dental plan. There is not much money here.

So what is a sales pitch? Well, they try to sell Medicare Advantage plans based on what I call shiny stuff. These are plan features that have nothing to do with your basic health care needs. It could be dental benefits, a gym membership, free access to the doctor’s office, or even a portion of your Part B premium back. All of this shiny stuff comes with giving a big part of your primary care coverage. But this fact was completely denied by the selling agent.

The pitch is usually like this; The agent will ask you to switch from Original Medicare to a Medicare Advantage plan. Usually a zero-premium plan that includes some dental coverage or a gym membership. They will tell you that you can keep your TRICARE because it is still secondary coverage, but it is to your advantage because you now have dental coverage.

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When you exchange your Original Medicare for a Medicare Advantage plan, you lose the two Original Medicare benefits I mentioned earlier.

First, you cannot see any medical provider in the US unless they accept Medicare. You will now be limited to the Medicare Advantage plan’s network of providers. Seeing out-of-network providers may or may not be allowed by the Advantage plan.

Second, instead of your health care decisions being between you and your doctors, it is now the insurance company that manages your health care. That is necessary. Your doctor must obtain permission from the insurance company for any procedure or treatment. The insurance company may deny the procedure or delay the procedure for up to two weeks. I have seen it for urgently needed chemotherapy and even dialysis and organ transplants.

If you want to learn more about the disadvantages of Medicare Advantage plans, check out my article titled “The Disadvantages of Medicare Advantage.”

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In another article I discuss the Inspector General’s report, actually two reports. The Inspector General of Health and Human Services produced an original report on Medicare Advantage plans released in 2018 that found insurance companies routinely deny services to consumers as a revenue-raising tactic.

When you have a Medicare Advantage plan, your doctor can’t perform the procedure without his or her permission. Except in emergencies. For other procedures, the insurance company may simply say no and let you fight for your health insurance.

The inspector general then followed up that report in 2018 with one released in 2022. In the latest study, they found nothing had changed. The way Medicare pays for Medicare Advantage plans encourages them.

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