Tricare And Mapd Plans

[RunnerDude]

I have heard conflicting opinions about writing MA-only plans for retired Tricare and Tricare for Life beneficiaries (who also have Medicare A & B). I have spoken with WellCare and Humana, who both say that there is no problem. I have read multiple articles that say that there is no problem (in fact encourage it)- as long as the client understands that there is a network they must adhere to. Humana also sent a portion from the CMS handbook that supports it (or at least does not discourage it). According to what I have read, Medicare (original Medicare or MA-only plans) will pay first and then Tricare will cover the remaining portion- as long as both Medicare and Tricare cover the service provided. Additionally, if Medicare does not cover the service, Tricare will still pay a portion of the claim based on their contracted agreement. On the other hand, I have also spoken with several agents who say that this is an inappropriate practice- but offer no real explanation why (if there is one). I don't want to do something I will later regret, but I need to understand the real reason(s) why it is not appropriate. These plans offer a lot of additional benefits that would be very useful to retired military beneficiaries, which should be available to them unless it causes a problem with their coverage. I would appreciate a response from anyone who can provide me with any good solid advice. Thanks

 

[TwoCents]

Humana sells MA-only plans branded as "Honor" aimed at the veteran crowd so what do you want them to say? When Dad turned 65, he had to take Medicare and his Tricare became Tricare for Life. He chose an Honor plan and has been really happy. He has raved about the over the counter benefit and loves that there's a Part B rebate. So far no problems with getting medical care and he uses his benefits often. I haven't asked to see his papers to see who's paying what. One thing to be mindful of is that of you know the person you're working with has Medicaid (and/or Extra Help) that of they enroll into an MA-only they have to be mindful that CMS wants them to have drug coverage and the carrier will place them into an MAPD unless the person opts out. So they have to pay attention to calls/mail!

 

[RunnerDude]

Thanks for your response- that helps a lot. Not sure why so many agents steer away from TriCare and Medicare beneficiaries. My FMO strongly discourages it- but I’ve yet to hear a solid reason why.

 

[DonP]

Runner

Humana sells MA-only plans branded as "Honor" aimed at the veteran crowd so what do you want them to say? When Dad turned 65, he had to take Medicare and his Tricare became Tricare for Life. He chose an Honor plan and has been really happy. He has raved about the over the counter benefit and loves that there's a Part B rebate. So far no problems with getting medical care and he uses his benefits often. I haven't asked to see his papers to see who's paying what. One thing to be mindful of is that of you know the person you're working with has Medicaid (and/or Extra Help) that of they enroll into an MA-only they have to be mindful that CMS wants them to have drug coverage and the

I have heard conflicting opinions about writing MA-only plans for retired Tricare and Tricare for Life beneficiaries (who also have Medicare A & B). I have spoken with WellCare and Humana, who both say that there is no problem. I have read multiple articles that say that there is no problem (in fact encourage it)- as long as the client understands that there is a network they must adhere to. Humana also sent a portion from the CMS handbook that supports it (or at least does not discourage it). According to what I have read, Medicare (original Medicare or MA-only plans) will pay first and then Tricare will cover the remaining portion- as long as both Medicare and Tricare cover the service provided. Additionally, if Medicare does not cover the service, Tricare will still pay a portion of the claim based on their contracted agreement. On the other hand, I have also spoken with several agents who say that this is an inappropriate practice- but offer no real explanation why (if there is one). I don't want to do something I will later regret, but I need to understand the real reason(s) why it is not appropriate. These plans offer a lot of additional benefits that would be very useful to retired military beneficiaries, which should be available to them unless it causes a problem with their coverage. I would appreciate a response from anyone who can provide me with any good solid advice. Thanks

carrier will place them into an MAPD unless the person opts out. So they have to pay attention to calls/mail!

Runner I just was on Humana 90 min call on tricare and champ va . Honor from Humana and patriot from United are ma only plans . Humana becomes first payor and Tricare for life the second payor . Drug coverage stays with Tricare for life which is awesome coverage .Tricare picks up all copays and out of pocket Humana doesn’t . Just like with Tricare the client can go to any dr they want as tricare picks up and out of network charges .It’s a win win for client . The only pia is client must tell all drs to bill tricare also as they’ll get bills . Champ va doesn’t pick up the out of network charges when someone has a ma

 

[RunnerDude]

Thanks for the info. Besides Champ VA, do the rest of VA and Tricare plans pick up the co-pays left by MA- only plans out of network?

 

[vic120]

Runner



Runner I just was on Humana 90 min call on tricare and champ va . Honor from Humana and patriot from United are ma only plans . Humana becomes first payor and Tricare for life the second payor . Drug coverage stays with Tricare for life which is awesome coverage .Tricare picks up all copays and out of pocket Humana doesn’t . Just like with Tricare the client can go to any dr they want as tricare picks up and out of network charges .It’s a win win for client . The only pia is client must tell all drs to bill tricare also as they’ll get bills . Champ va doesn’t pick up the out of network charges when someone has a ma

This is strange hearing this now, When I started with the agency, We did maj medical but got into humana MAPDs in 2009

Humana came in did the training and they set up with the call center I worked at for call-in enrollments

But one thing that was hammered into us Both by Humana and the company I worked for did not sing up for Tricare because MA does not work with Tricare or that it will negatively affect

I have heard this from several FMO's I work with as well over the years

Has something changed or has everyone been wrong all this time?

I mean clearly, it works As you all have mentioned

 

[MedicareAgent]

I have an agent that put a tricare on an ma plan, disaster !! Billing was a nightmare, dr's didn't bill right, customer getting bills etc, why would you mess with tricare?

 

[LostDollar]

Two possibilities I see from reading posts here are:

Buying in to MA carriers' promotions about additional, non-medicare benefits such as OTC coverage and dental, vision, hearing coverage.

Additional MA/MAPD commissions.

In the final analysis, this may just be another dimension to the sell or don't sell MA discussions.

 

[DonP]

Correct it’s the billing issue . The dr must bill both are the client will get bills . But if the want the dental and otc benefit they must do it .

 

[PaBroker]

Like most agents, I was trained to run for the hills whenever Tricare was mentioned. Last AEP I had a beneficiary pester me to enroll her in an MAPD plan. We researched the issue together and determined it would work. A year later she is happy with the coverage.