Medicaid + Tricare + Medicare

[somarco]

Talked to a lady (64) that has Tricare Standard (her term) as a survivor of a Veteran with 20+ years. She also has Medicaid, which I believe is primary and Tricare pays after.

She turns 65 in October and will sign up for Medicare. Assuming she is eligible to continue with Medicaid, it looks like each plan pays in this order . . . Medicare, Medicaid, Tricare.

It would seem that Medicaid + Tricare is redundant.

What am I missing?

 

[T Sparks]

Talked to a lady (64) that has Tricare Standard (her term) as a survivor of a Veteran with 20+ years. She also has Medicaid, which I believe is primary and Tricare pays after.

She turns 65 in October and will sign up for Medicare. Assuming she is eligible to continue with Medicaid, it looks like each plan pays in this order . . . Medicare, Medicaid, Tricare.

It would seem that Medicaid + Tricare is redundant.

What am I missing?

The MedSupp, It will pay 4th JK

 

[policywunk]

Talked to a lady (64) that has Tricare Standard (her term) as a survivor of a Veteran with 20+ years. She also has Medicaid, which I believe is primary and Tricare pays after.

She turns 65 in October and will sign up for Medicare. Assuming she is eligible to continue with Medicaid, it looks like each plan pays in this order . . . Medicare, Medicaid, Tricare.

It would seem that Medicaid + Tricare is redundant.

What am I missing?

Medicaid or more specifically a Medicare Savings Program will pay her part b premium and it will not affect how her Medicare and Tricare work together.If she does get QMB medicaid (usually less than 1100 income and less than 8000 assets for single which usually they have to apply for even if they currently have " straight medicaid" before turning 65 ) then she may want to consider a SNP MA if they have good ones in her area for the extra benefits which can be substantial like 250 monthly food/utilities card,4000 dental including dentures,0 copay for all drugs etc.Low income people love these extra benefits.Of course whether her providers are in network or if she is willing to change providers is key.

 

[StephanieCJ]

Tricare Standard is now Tricare Select. Depending on how she qualifies for it, it may not cost her anything, and if that is the case, it wouldn't hurt to keep it. It does have co-pays/co-insurance for certain things, so doesn't cover 100%. May help if she wants to see a doctor that doesn't take Medicaid but does take Tricare.

 

[policywunk]

Tricare Standard is now Tricare Select. Depending on how she qualifies for it, it may not cost her anything, and if that is the case, it wouldn't hurt to keep it. It does have co-pays/co-insurance for certain things, so doesn't cover 100%. May help if she wants to see a doctor that doesn't take Medicaid but does take Tricare.

I believe Tricare Select convers to Tricare for life medicare wrap around automatically when they become eligible for medicare?

https://www.tricare.mil/Plans/HealthPlans/TFL

 

[DonP]

Are you sure you can have tricare and full Medicaid ? Tricare is like a med sup and you can’t have a med sup and Medicaid . Tricare is not going to want to pay as Medicaid is secondary . I’m suprised she qualifies for Medicaid as a spouse of a deceased veteran would seem to make over $1100 a month .That could be a disaster in billing . If I were her I’d certainly never drop tricare as she could lose Medicaid at any time . Here’s another issue . If she’s on Medicaid she got a pdp card . How will that work with tricare which has drug coverage ? If you write a Mapd and not ma with tricare it screws up their express scripts drug coverage .

 

[somarco]

MSP seems to be state specific, and the state Medicaid office determines eligibility.

Tricare Select changes to TFL when you turn 65 AND enroll in Medicare A & B . . . at least, that is the way I read it.

Tricare Select/ TFL appears to pay secondary to other insurance (private and govt such as Medicaid).

She is in poor health, limited mobility and pretty much bedfast for now at least (based on earlier conversation). Recovering from a car accident, no money to have it repaired.

This is a straight pro-bono situation . . . not looking to make money off this but I don't want to make her situation worse. I spent about 20 minutes on the phone and had an idea in the first 5 this was a $0 case if I took it on. Often I get referrals from folks where I never earned a dime off them.

This may seem foreign to guys (and gals) who are constantly looking at commission dollars vs helping someone out but I do almost everything different from the crowd. Do what's right and the money will follow. It always does . . .

At this point it looks like Medicare + TFL is a good match . . . especially if she can continue to get Medicaid and/or MSP. She is already connected with the state for Medicaid, so I presume they can guide her home to MSP if she qualifies.

She will be 65 in a few months so Medicare as primary should open more doors for her vs Medicaid.

I want to help her access the best possible care with the fewest hoops to jump through and minimal OOP.

Some of the options mentioned may work but seem overly complicated, especially for a woman that seems to have a limited ability to follow direction.

She has watched several of my videos and understood the basics, so I don't want to confuse her or put her on a different path unless necessary.

Thanks for the feedback

 

[policywunk]

Are you sure you can have tricare and full Medicaid ? Tricare is like a med sup and you can’t have a med sup and Medicaid . Tricare is not going to want to pay as Medicaid is secondary . I’m suprised she qualifies for Medicaid as a spouse of a deceased veteran would seem to make over $1100 a month .That could be a disaster in billing . If I were her I’d certainly never drop tricare as she could lose Medicaid at any time . Here’s another issue . If she’s on Medicaid she got a pdp card . How will that work with tricare which has drug coverage ? If you write a Mapd and not ma with tricare it screws up their express scripts drug coverage .

You never drop Tricare but you can decide to not use it.With MAPD as primary to Tricare she will have to get drugs on base if they still want to use Tricare Rx so if in the rare occasion where tricare with MA is suitable it should be a MA only as to not affect the tricare drug coverage unless the PDP is much better and/or they don't care about going to base to use tricare rx.Someone who qualifies for medicaid is going also getting extra help so they are not giving up anything using PDP in fact it is usually going to be better than Tricare rx.If they have access to a good snp mapd in their zip code as joe nameth says it will be even more better because they will possibly get all drugs for 0 copay.

Although it's rare I have ran in to surviving spouse of retired military who have Tricare and medicaid

 

[StephanieCJ]

Tricare and Medicaid can exist together. Tricare functions like a Supp but is not a Supp. MAPD would not be a good option because Tricare will fill in the copays, but the client would have to pay them first and then file for reimbursement. PDP does not automatically come with Medicaid in all instances. I would leave her exactly as is if the select is going to become TFL (I didn’t read up on it, so I’ll take your word for it on this one). Less hassle for her if left alone.

 

[DonP]

Medicare/ Medicaid/ Tricare .What would Tricare pick up from Medicare/ Medicaid? There’s nothing to pick up . Please show show me were you can stay on

Tricare and Medicaid can exist together. Tricare functions like a Supp but is not a Supp. MAPD would not be a good option because Tricare will fill in the copays, but the client would have to pay them first and then file for reimbursement. PDP does not automatically come with Medicaid in all instances. I would leave her exactly as is if the select is going to become TFL (I didn’t read up on it, so I’ll take your word for it on this one). Less hassle for her if left alone.

I sell 30 honor ma a yr with tricare for life . Part b giveback going to $150 a month next year . I have never gotten even 1 call from a client that they had to pay a dime . If they show their Humana card and tricare its seemless if the providers bill both which they all seem to do . As I said I’ve never run into a TFL with Medicaid so Ive not had to deal with it . I do run into people who 100% use the va and are on partial Medicaid . They might not have part b and I tell them the state will pay for it . They get their part b and I put them on a partial dual with a food card .