Medicaid + Tricare + Medicare

[policywunk]

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.

Really should do a needs analysis before making blanket statements like that.Someone with Tricare and medicaid MAY be better off with a snp ppo if they are happy with plans network because they could get a lot of extra benefits not covered by medicare ,tricare or medicaid.Not just fluff anymore but serious benefits like a debit card for 200 a month for food/utilities ,dentures and even implants on some plans ,eyeglasses etc.This is important to low income people and BTW If they have the income level to qualify for medicaid they will be auto enrolled in to a PDP anyway if they don't choose a plan.The PDP will always be better rx coverage than Tricarerx if they are at the medicaid level income and there drugs are on formulary.

Also if someone is on a MA plan as primary the provider can file to Tricare for secondary reimbursement but not all of them will do it.Still a few cases where MA and Tricare is suitable but you have to be very careful.I personally have never written one but have ran in to few that have the combo and it is working for them.

 

[DonP]

Really should do a needs analysis before making blanket statements like that.Someone with Tricare and medicaid MAY be better off with a snp ppo if they are happy with plans network because they could get a lot of extra benefits not covered by medicare ,tricare or medicaid.Not just fluff anymore but serious benefits like a debit card for 200 a month for food/utilities ,dentures and even implants on some plans ,eyeglasses etc.This is important to low income people and BTW If they have the income level to qualify for medicaid they will be auto enrolled in to a PDP anyway if they don't choose a plan.The PDP will always be better rx coverage than Tricarerx if they are at the medicaid level income and there drugs are on formulary.

Also if someone is on a MA plan as primary the provider can file to Tricare for secondary reimbursement but not all of them will do it.Still a few cases where MA and Tricare is suitable but you have to be very careful.I personally have never written one but have ran in to few that have the combo and it is working for them.

The key for Tricare and ma to work the ma must be a ppo were you can go out of network . If it didn’t work every time I’d never still be writing . Some honor plans are hmo’s . That don’t work

 

[sshafran]

I don't know *exactly* the right thing, but I would start with helping her apply for extra help, and make sure the box stays checked for Medicare Savings program.

This way you know that her Medicaid might "transition" from under 65 Medicaid to 65+.

If she gets Tricare for Life it won't pay the $170, whereas mpap would, so in this case it is worth it to have both if she can qualify.

 

[somarco]

I don't know exactly the right thing either and this is a Hippocratic thing for me . . . "First, do no harm"

Talked to her again this afternoon . . . she thinks she has Medicare and SSI . . . which makes no sense. I asked if she was disabled, she said no, but her husband was and he died 3 years ago, so she thinks she is collecting on his SSI.

When I told her Tricare pays AFTER Medicaid or Medicare she said "No", Tricare is primary. My doctors and hospital file with Tricare then they bill me the balance and I file with Medicare but I still have a lot of out of pocket. I live with my daughter and she tries to help me.

Now I have to find out not only what she has, but how to get a refund for 3 yrs worth of claim filed improperly . . . if that is even possible.

What a mess and I still don't know for certain what she has, but I suspect SSDI, Medicare and Tricare but the Tricare claims were filed incorrectly. She is not sure if she has Medicaid or not, and I don't know either.

She is 200 miles from me and I am not driving there, even if there was a chance of making a buck. Gotta be the the coach, not a player in this game.

 

[DonP]

I don't know exactly the right thing either and this is a Hippocratic thing for me . . . "First, do no harm"

Talked to her again this afternoon . . . she thinks she has Medicare and SSI . . . which makes no sense. I asked if she was disabled, she said no, but her husband was and he died 3 years ago, so she thinks she is collecting on his SSI.

When I told her Tricare pays AFTER Medicaid or Medicare she said "No", Tricare is primary. My doctors and hospital file with Tricare then they bill me the balance and I file with Medicare but I still have a lot of out of pocket. I live with my daughter and she tries to help me.

Now I have to find out not only what she has, but how to get a refund for 3 yrs worth of claim filed improperly . . . if that is even possible.

What a mess and I still don't know for certain what she has, but I suspect SSDI, Medicare and Tricare but the Tricare claims were filed incorrectly. She is not sure if she has Medicaid or not, and I don't know either.

She is 200 miles from me and I am not driving there, even if there was a chance of making a buck. Gotta be the the coach, not a player in this game.

Call United , Humana , WellCare , Aetna etc . Get her name , dob and ss # and call them . Tell them you need to run a Medicaid check . They’ll tell you if she has any level of Medicaid.

 

[AugustaMi]

Good thread.

This one has confused me in the beginning. Have yet to run into a Tricare/Medicare/AND Medicaid though

Have quite a few on Tricare or VA with MA (Aetna/Humana/HAP). No complaints. People love it. One of my first appts last October, I got a referral from a Tricare Lady who specifically asked for Aetna MAPD. Zero complaints. She used the dental and that's what she wanted it for in addition to going to docs she felt like going to. I only have a few with MAPD. I'd opt for MA only if they don't mind VA. To date, I only have 3 on TFL with MAPD and that's with some 'splaining to understand that there could be billing errors.

I gleaned alot of information on the Humana VA webinar training for this. Unfortunately I've heard nothing about Medicaid in the mix, so this is a good thread to actually learn a little more.

Only issue that has come up with MAPD/MA with Tricare is to watch for billing errors. Sometimes theyll get co pays billed when TFL will pick up the copays if it's billed properly. On the webinar there was an open questions section where there were actual agents who also have both TFL/VA-MA/MAPD. That was the one thing to watch for. I haven't heard this yet with any of my clients. Not sure how the Tricare select would work, but I'm watching this thread to learn as much as I can.

Oh I take that back, one more thing. On the Rx, if youre not careful, meds can be higher on MAPD than at the VA. MA is the better option bc of this if they use VA for meds. I saw an issue with this as well in the field. It was a minor higher price for an Rx by $15 or so and the client complained so I put her on MA during OEP. Had she not called me I never wouldve known. these can be a little tricky. That example I'm sure cuoldve been hella worse.

The thing that pops in my head here is that you may end up with more service work than you want. Medicaid/DSNP with MAPD can be an issue as I learned in my first year. All 3 of those together, I wouldn't be surprised if a glitch came up. Hope this makes sense, I'm moving fast today.

 

[MedicareAgent]

I don't touch anyone tricare, it pays 100%,

 

[DonP]

I don't touch anyone tricare, it pays 100%,

Aren’t you in Fla ? As I recall almost all the honor plans are HMO’s? This is a disaster with an hmo and works seamlessly with a ppo . I’ve seen $150 part b givebacks fir honor plans next yr . That pays there whole part B . It’s big

 

[somarco]

I have a few TFL clients plus a few others that use the VA for primary care and sometimes Rx if they are near a VA hospital. Others in the boonies use the MBM program.
Meds by Mail (MbM) - Community Care

The VA system has their own formulary, so not all meds are covered. Also some of the higher priced med's are not in stock and have to be ordered ahead.

All of my clients have a Medigap which allows them to use any provider, plus no referrals or pre-authorization . . . some pick up a PDP if they travel a lot.

There are 13 military bases in GA, 3 are in Atlanta, the rest spread out in other parts of the state. We also have 3 VA hospitals . . . Atlanta, Dublin and Augusta . . . and 27 clinics.

I don't target that market but also don't run away. Ran into a widow with ChampVA a few weeks ago and had to research how it works. I might see 3 or 4 Tricare situations per year and have to look them up as well.

My book is simple . . . my clients and I like it like that . . . makes semi-retirement a bit easier.

 

[StephanieCJ]

https://www.tricare.mil/medicare

Link above if anyone would like to read further, but the info below is copy/pasted directly from the official site. If they are fine paying the copays at time of service and filing for reimbursement, then MAPD may be an option, but if someone is on Medicaid, there is a stronger likelihood in my experience that there may be a knowledge gap for them in getting that done. If my "blanket statement" is wrong, so is the Tricare website...

• Medicare Advantageplans (also known as Medicare Part C) are a Medicare coverage option offered by private companies that contract with Medicare. Medicare Advantage plans provide all of your Part A and Part B services and usually Part D pharmacy coverage.
• You may pay a plan premium each month in addition to your Medicare Part B premium.
• You must get all your health care services from the Medicare Advantage plan’s network of providers. This doesn’t apply to emergency services.
• If you enroll in a Medicare Advantage plan, you’ll have to pay copayments at the time of service.
• TRICARE For Life can reimburse you for copayments you paid for TRICARE services. You’ll need to file your own claims.