FEHBP, group insurance, and Medicare

Nov 29, 2008

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  1. retread
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    retread Guru

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    I learn something new every day!

    Yesterday, I came across a retired government worker that wanted an MA plan for their spouse who is on Medicare. During the census I took, I learned that the group insurance they had was going up, and I thought I had a sale....

    The retiree told me at one point that, although the group insurance is secondary, Medicare pays the spouse's group co-pays. Since Medicare was primary, they thought they needed an MA plan which would be more affordable. Say what? I asked them if they were FEHBP, and they said yes... I said you gotta be kidding, Medicare is performing like a supplement to their group, and they have no out of pocket expenses other than their premiums!

    The group insurance is a PPO, but the co-pays are picked up by Medicare under FEHBP! Furthermore, they get a premium reduction on their group insurance for having Medicare. WOW!

    I looked this up on the FEHBP web site and confirmed this. Thought you guys should know....:GEEK:

    No sale, but a successful visit that helped some seniors!
     
    retread, Nov 29, 2008
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  2. policy doctor
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    You're such a good boy scout, RETREAD! Proud of you.

    Sign of a AAA agent.
     
  3. insureyou2@
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    how would it work with tri-care for life?
    if medicare primary and tri-care secondary would a ppo that offers dental and vison work?

    i would think the ppo would replace medicare and tricare would make the difference in copays just dont know how the billing would work with tri care for life.:nah:
     
  4. jdeasy
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    If they have Tricare, they should have dental and vision coverage and don't need to mess with their healthcare coverage.
     
    jdeasy, Nov 30, 2008
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  5. Russ
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    My mom has Tricare and Medicare....and yes, she has 100% coverage for hospital and doctor charges.

    Where I live Tricare is everywhere and has cost me thousands a year in renewals and sales.
     
    Russ, Nov 30, 2008
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  6. insureyou2@
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    i do not think tri care for life has vison, I dont think I would mess with it any way. Just wanted to see if any one may have put thier foot in the water? In Idaho blue cross is 0 premium if client gets drugs from V.A
    Plan has dental and vison and works well with vets that generally get all thier care at V.A and most only use as back up.
     
    Last edited: Nov 30, 2008
  7. jdeasy
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    She has to have Medicare to have Tricare. The person must have Medicare A & B. Medicare is primary, the Tricare pays. They don't have to go to a VA doctor or hospital, they can go to any medicare Dr. or facility. It's a fancy med sup. It does include dental and vision. Glasses and/or contacts are not automatically included, but, most members can qualify to get them paid for.

    Since Tricare for Life is secondary to Medicare, I believe one could do a Tricare member great harm by enrolling them in a separate MA plan.
     
    jdeasy, Dec 1, 2008
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  8. midwestbroker
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    midwestbroker Guru

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    I went through a BCBS book of a federal retiree.

    Page 116 in their book will explain that they can either keep their BCBS federal plan and have the MA (will coord benefits). OR they can drop the BCBS and take the MA but they can pick back up the BCBS next enrollment period.
     
  9. Russ
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    Agree. Best to leave them alone...possibly sell them a LTC policy.
     
    Russ, Dec 1, 2008
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  10. midwestbroker
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    My experience with Tricare:

    Ran an appointment last year and the guy had Tricare. He wanted to add Coventry to his insurance. He had called his administrator to see if this would work.

    The administrator said that it would work as long as he only used one or the other when it came to drugs. As for Dr visits, he had his choice. He could present the tricare card or the Coventry card, not both.

    I was reluctant to enroll him but he wanted it (mostly for the free gym membership) and I enrolled him. As far as I know everything was ok.

    Would I do it again?? Only if the person insisted and I would put in a note with the app saying against my better judgment they chose to have the insurance.
     
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