TriCare

[Packerland]

I have seen a couple of discussions regarding Tri-Care.

I hope this clears it up for some of you.

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

 

[sshafran]

I have seen a couple of discussions regarding Tri-Care.

I hope this clears it up for some of you.

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

I usually recommend MA Only for them. I have many TriCare clients (I live near Camp Lejeune).

I walk them thru the claim process of OM + T4L vs MA + T4L.

And yes, I bring up PA.

Because T4L pays secondary on both OM and MA, with a good PPO it only makes sense. They even pay secondary out of network for those who are curious.

 

[sshafran]

 

[sshafran]

Additionally, some providers are willing to assist on the dual claims ie they'll bill MA and they'll assist with the WPS.

 

[DonP]

Additionally, some providers are willing to assist on the dual claims ie they'll bill MA and they'll assist with the WPS.

I’ve written a ton . Never 1 issue yet . Even works the same with champus .My question is what happens in snf facility ? Since they have a secondary sup with tfl will Humana still try to kick them out after 8 days . I find it hard to believe since much of the bill paid for by tfl .

 

[Packerland]

Yes MA only....do not write MAPD...

 

[sshafran]

I’ve written a ton . Never 1 issue yet . Even works the same with champus .My question is what happens in snf facility ? Since they have a secondary sup with tfl will Humana still try to kick them out after 8 days . I find it hard to believe since much of the bill paid for by tfl .

If they really run into issues - SEP out of MA to OM. No problem.

 

[DonP]

I’ve written a ton . Never 1 issue yet . Even works the same with champ for life .My question is what happens in snf facility ? Since they have a secondary sup with tfl will Humana still try to kick them out after 8 days . I find it hard to believe since much of the bill paid for by tfl .

If they really run into issues - SEP out of MA to OM. No problem.

Correct .What’s the sep in June or July for instance ? Ive been told they can call Medicare at any time and they’ll disenroll them . Also what happens if they disenroll and are in skilled nursing for 30-40 days with only one? They’ll have big out of pocket .

 

[sshafran]

Also what happens if they disenroll and are in skilled nursing for 30-40 days with only one? They’ll have big out of pocket .

I usually tell people, "I can't tell you what T4L covers" but between us on the forum their SNF coverage is appears to be better than medigap (I don't see a day 100 cap)

[EXTERNAL LINK] - Skilled Nursing Facility Care | TRICARE

So if on MAPD, they'll have SNF copays (just like OM, but usually lower), and TFL could follow as secondary. I'm not seeing a big downside/risk here.

 

[policywunk]

Additionally, some providers are willing to assist on the dual claims ie they'll bill MA and they'll assist with the WPS.

If they are full dual i didn't think Tricare even comes in to play unless they go out of network to a provider who doesn't accept medicaid? i have a few people with tricare on snp ppo and have never had an issue.