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PTAgentInNJ, are Aetna's Eagle or UHC's Patrot plan in their County as well?
Tricare And Mapd Plans
- Thread starter RunnerDude
- Start date
PTAgentInNJ
Expert
- 23
Eagle is but Patriot isn't. Eagle doesn't have a Part B reduction here
- 4,138
First off--appreciate all the info in this thread--it's been an interesting read and I'm definitely still learning where this issue is concerned (and frankly on all Medicare fronts despite being several years in).
I have an appointment today to enroll a veteran with T4L into a Humana Honor PPO MA only plan. Here in NJ the plan offers "up to" $55/month in part B reimbursement. When I discussed the plan with the enrollee and after having left the materials with him for awhile to review, his take was that he wants to enroll for that savings. Appreciate any additional thoughts on that or the PPO network piece.
Here are some excerpts from the 2 page brochure Humana made available for the plan.
The combination of VA healthcare and a Medicare Advantage plan provides more options for coverage and care
Advantages of Medicare Advantage
• Non-VA emergency room
• Choices and access to more providers, second opinions and specialists, Rx formulary options
• Potential savings opportunities
• Plan extras
• A Medicare Advantage plan won’t impact your VA benefits
So, you can see by the brochure that it's geared towards VA Benefits and not T4L, which are two different things.
If he's going to the VA for the vast majority of his care, the MA is a great option because it gives him access to non-VA providers and additional services the VA doesn't offer. The VA can't bill Medicare or Medicaid.
For T4L, on the other hand, is a Medicare wraparound that has no premium. Think of it like an enhanced MS.
Moving TFL to MA is significantly limiting options and care. Even with the 660 premium payback per year, it's just not worth it.
So this is what I am trying to find out, In the past this is what I thought and was taught
However, what some are saying here is they are not losing anything from T4L only getting extra from MA but still can use T4L outside of MA network
So I still don't know if I was taught correct or have I been wasting opportunities to enhance people T4L all this time
PTAgentInNJ
Expert
- 23
Awesome info--thank you. I will ask him again how he's receiving care before we do anything with the application. I'll look to discourage him if he is T4L as opposed to VA. I wasn't clear on the difference.
No one asked but for the record I didn't pitch this plan to him. I wouldn't have given my lack of knowledge. I enrolled his wife in an Aetna MAPD and he asked specifically about this Humana Honor plan as I was exiting the home and I later dropped off the plan docs. My guess is he knows someone already enrolled and they piqued his interest.
TRG1225
Super Genius
- 213
Yes and no. For the most part, I would leave T4L's alone. However, when working for Humana, there have been some T4L folks that were adamant I sign them up for a policy. They knew the ins and outs better than anyone in the call center.
Like others have said (and sorry, a lot of what I'm saying is rehashed from earlier posts in this thread, especially runnerdude and wln417), they HAVE to stay within the MA plan's network for T4L to pick up the copay they would otherwise pay on an MA with no T4L. That much is for certain.
The part that isn't detailed as clearly as it should be when talking about this with carriers, I think, is what happens if they receive care outside of the network? What would happen is that T4L wouldn't pick up, as it won't pay more than the primary insurance. If there is no primary insurance, then there is no T4L coverage, unless the care is received at a military or federal healthcare provider.
I think a lot of agents brush over that, especially when the wording used is "If Medicare doesn't cover it, Tricare still kicks in." That's not really the case and I think that gives the beneficiary the implication that they can still go to the provider of their choice if not explained correctly.
The only things that Medicare doesn't cover that T4L does besides care in a military or federal facility would be Rx's, overseas care, and I think chiropractic services. It's very limited.
To sum it up, it's safe for T4L beneficiaries who see a limited amount of providers that are in network and understand the ramifications of going out of network. If they are looking at a MAPD, they need to know it will become a paperwork situation with their Rx coverage. For some that only take Tier 1's, they don't care because they prefer to go to the local Walgreen's or CVS and don't have a copay anyway. If any Tier 3-5's are involved, then it isn't in their best interest at all I would say to go to an MAPD.
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PTAgentInNJ
Expert
- 23
Just to close the loop on my appointment. He is a VA person not T4L and was very familiar with the MA interaction so we completed the enrollment.
Up to . . . .
What is the lower end?
It's interesting what motivates buyers.
Some buy for the "free gym membership", others because there is no monthly premium, some buy so they don't have to pay for a drug plan the "don't need", and others buy for the "free dental and vision coverage"
That's like buying a car because you really like the paint job.
None of those reasons (for buying) are worth a damn if you can't get access to quality health care without having to jump through hoops.
Agree or disagree?
PTAgentInNJ
Expert
- 23
$0 is the low end I think. My understanding is they get the $55 unless they are participating in a Medicare Savings plan that is reducing their Part B cost already and then depending on that help the reimbursement can be prorated or eliminated. Apparently my new enrollee was getting that $55 from a prior Aetna plan that is no longer available here (I think it was the Eagle which is still available but no longer has a Part B reimbursement for 2021) and said he isn't in any of the MSP's so he should get the $55
Part B reimbursement varies from carrier to carrier and year to year. I know it was big in FL at one time, maybe still is.
It's odd what motivates folks to buy one plan over another.
To me it is foolish to chase the glitter. Those extra's are great as long as you are healthy but they don't pay the bills when you need critical care.
Some beneficiaries, and agents, are very short-sighted.
