Tricare

[midwestbroker]

So I have a TRICARE question.

I know that TRICARE will act as the second payer to Medicare.

What if the a person joins a MAPD plan and the out of pocket is 70/30 (as opposed to Medicare's 80/20)? Will TRICARE pick up the 30%?

From what I understand they will, but I wanted to know if any other agents have a different experience.

Thanks!

 

[jdeasy]

So I have a TRICARE question.

I know that TRICARE will act as the second payer to Medicare.

What if the a person joins a MAPD plan and the out of pocket is 70/30 (as opposed to Medicare's 80/20)? Will TRICARE pick up the 30%?

From what I understand they will, but I wanted to know if any other agents have a different experience.

Thanks!

From experience, the ones that I know of that have tricare and are in an MA plan, Tricare pays ust as if they were in original Medicare.

The question would be why would would you put a Tricare person into an MAPD? They don't need it and it limits their options instead of adding to them. I've helped several Tricare individuals get out of MA/MAPD plans.

 

[G.Gordon]

Kinda what I was wondering.

 

[Chazm]

Usually with the tri care folks I know they are set and could really only market final expense and LTCi to them.

Where I'm a little confused is with people with VA benefits. Is this different than tri care? I assume it is. I've spoken with one guy who isn't too happy about having to only use his VA doctors but doesn't want to lose that benefit and his drug benefit.
Will a MA benefit him? Would he lose VA benefits? Someone in my office said no, but I wanted to look more into it.

 

[midwestbroker]

I have had people with TRICARE come to me and ask for a MAPD. I know of one that just wanted the gym membership.

VA and MAPD plans do not coordinate benefits. If you go to the VA, then the MAPD steps out of the picture and they are all VA. When they come out of the VA they are back under the MAPD plan. They can have both with no issues (well, I have had no problems with my VA members).

One advantage of VA and MAPD is that their drug cost may lower (generic drugs @ the VA are $8.00 per month and $24 for 90 days). I have clients that use the MAPD as a back up plan for the VA (since there is $0 premium).

But in both situations, it all depends on how the client will use the benefits and if the plan would be a good fit for what they want to happen.

 

[retread]

Usually with the tri care folks I know they are set and could really only market final expense and LTCi to them.

Where I'm a little confused is with people with VA benefits. Is this different than tri care? I assume it is. I've spoken with one guy who isn't too happy about having to only use his VA doctors but doesn't want to lose that benefit and his drug benefit.
Will a MA benefit him? Would he lose VA benefits? Someone in my office said no, but I wanted to look more into it.

I'm with the others that avoid selling MAs to TriCare. However, unlike TriCare, regular VA benefits for veterans that did not retire or have a service-connected disability, MAPDs can be useful (as in the cases Midwest broker speaks to).

Just remember, a VA qualified vet can use either his VA benefits OR his MAPD benefits, but not both for the same reimbursement. A claim may be filed with both plans, but only reimbursed for each plan's coverage limit without duplication.

In the case of an ER visit, if he goes to the VA hospital, they will take him, but under VA benefits. If he goes to a MA network hospital, he pays the MA co-pay.

If he goes to the VA for Rx, he pays the VA rates. If he gets Rx from the MAPD plan, he pays the MAPD co-pay.