Tricare SEP

[Medicare bro]

Just had a potential client come in who has been on Medicare and Tricare for 10 years and has no SEP available. An agent from Bankers life got her on an Humana USAA plan using the SEP OTH OCC, is this legit? Can you just enroll someone into an MA at any point of the year if they have Tricare? Thanks!

 

[Fisher]

My experience has been no, the OCC SEP does not work that way. In fact, I tried this exact thing with Humana a couple of years and it got shot down.

 

[hockeyday]

Just had a potential client come in who has been on Medicare and Tricare for 10 years and has no SEP available. An agent from Bankers life got her on an Humana USAA plan using the SEP OTH OCC, is this legit? Can you just enroll someone into an MA at any point of the year if they have Tricare? Thanks!

It should work

 

[Medicare bro]

It should work

How? Can you explain? Thank you so much.

 

[hockeyday]

Call your humana rep, tricare is other creditiable coverage, now that being said I would never mess with tricare, now all of their billing will run thought Wisconsin payment services, I may not have the name right but it's a bunch of steps for all tricare claims that they don't have now

 

[PolicyProPal]

Technically, that app should’ve been declined by the carrier as the client did not already have an MAPD at the time the application for the MA-only was submitted—they were on OM and TFL. The SEP-OCC should only be used to enroll a client with creditable coverage that is currently on an MAPD into an MA-only plan, but as you know many carriers approve SEPs that should be declined. If you search “Tricare” in Humana university you should find the service aid and training that lays out the required disclosures that you have to read to VA/Tricare/ChampVA beneficiaries to ensure you deliver a compliant presentation. Of note, those plans can be more of a headache than they are worth especially for a client that has been on TFL for 10 years and is used to their claims being processed and paid automatically. When they enroll in the MA-only they may have to manually file their claims with TFL to cover their copays which can be a negative experience that leads to a sales allegation if not presented compliantly.