TRICARE For Life is wonderful health insurance that’s for more than just for retired military personnel. It covers the gamut from:
- Uniformed service members and their families
- National Guard and Reserve members and their families
- Survivors
- Former spouses
- Medal of Honor recipients and their families, and
- Others registered in DEERS (Defense Enrollment Eligibility Reporting System)
TRICARE For Life is a Medicare wraparound for TRICARE, when one turns 65 or is on disability for 24+ months (immediately if they have ESRD or Lou Gehrig’s disease).
However, many do not understand how TRICARE For Life works with Medicare, other than it’s a wraparound and that they must have Medicare Parts A and B in order to be eligible. Myth has it that if a TRICARE For Life beneficiary takes Medicare Advantage, they will lose their TRICARE coverage. Not true. It enhances their coverage and helps to plug holes in benefits. How you ask? Let’s take a look.
Number 1: How TRICARE Works with Medicare
When you have TRICARE For Life and Original Medicare, you have three possible scenarios when you see a doctor:
- If your service or procedure is covered by Original Medicare and TRICARE, Medicare is the primary payer. TRICARE pays any difference (typically any deductible and coinsurance Original Medicare does not pay). Remember, Original Medicare is an 80/20 Fee-For-Service plan with no MOOP (Maximum-Out-Of-Pocket) limit. Hence, without TRICARE, you would be stuck with the 20% balance and any deductible if you didn’t have a MediGap policy (a topic for another article).
- If the procedure or service is covered by TRICARE only, you pay any TRICARE copay or deductible there may be.
- If covered by Medicare only (a procedure not covered by TRICARE), you will pay Medicare’s deductible and 20% coinsurance (which can be substantial).
Medicare Comes in Different Forms
Notice that the beneficiary with Original Medicare and TRICARE did not lose his or her TRICARE coverage. Since you have the option of choosing how you wish to receive your Medicare benefits (Original Medicare or Medicare Advantage Part C), choosing a Medicare Advantage plan WILL NOT make you lose your TRICARE For Life coverage.
Now, with that said there are some changes that occur. Let’s look at these as well.
Medicare Advantage Becomes Primary
If you use your Medicare Advantage plan anywhere except at a military hospital or clinic (they do not accept Medicare, they only accept TRICARE or VA Benefits), it will be primary. Since it’s primary, if there are any copays, coinsurances or deductibles, you will be charged those. However, if it’s a fee TRICARE does NOT charge, you can submit form DD2642 (you can download it here) and TRICARE will reimburse you. Many medical practices are familiar with the process and will submit the form for you.
Now, you may think, “What if I’m hospitalized? That can be expensive! What if I don’t have the money to pay until I get reimbursed?” A valid concern. But keep in mind several things:
- Hospitals don’t hand you a bill when you are discharged. You will receive a bill in the mail, typically 30+ days later.
- You know what that bill will be because you have your Summary of Benefits. Your Summary of Benefits will tell you what your per diem copay is and for how many days. For example, you may have $125 per day, for the first four (4) days hospitalized. This equals $500.
- Upon being discharged, file the form with the proof of hospitalization and length of stay. When you receive your reimbursement, pay the bill.
Number 2: Many Medicare Advantage Plans Offer Part-B Premium Givebacks
When you have TRICARE For Life, you must have Original Medicare (Parts-A and Part-B). In doing so, you are paying whatever the Part-B premium is for the year (it goes up each year, in 2021 it’s $148.50). However, if you choose a Medicare Advantage plan that fits your needs with a Part-B premium giveback, you can lower what Medicare deducts from your social security check or you are billed for each month/quarter.
The way it works is that the plan provides a credit to Medicare in your name (or Medicare ID number). It can be anywhere from $30 to $144 per month (or more for 2022). Medicare then bills you the difference. So, if you received a $100 giveback/credit, your bill (in 2021) would be $48.50 instead of $148.50. You just got a pay raise.
Number 3: You Can Plug Benefit Holes in Your Coverage
Medicare Advantage plans are well known for their added benefits. Many veterans and/or dependents and government employees do not get dental. Medicare Advantage plans would provide that dental benefit. But it doesn’t stop there. Many also provide:
- Dental insurance or allowance (as mentioned above)
- Over-the-counter credits of $20 to $100 per month for items you currently buy at Walmart, CVS and Walgreens
- Food card for groceries
- Cash card for gasoline, bills or any other expense
- Gym memberships
- Chiropractic and acupuncture services
- Free meals after being discharged from the hospital delivered to your home
- And more, depending on the plan and location
When you add up the cash value of these benefits, it can be a huge windfall in savings that can equal $100s to $1,000s of dollars annually.
Work with an Agent Knowledgeable with Veterans’ Benefits and TRICARE For Life
While every insurance agent has your best interest in mind, not all understand the inner workings of TRICARE For Life and/or VA Benefits and Medicare. You will find some agents won’t even touch it, for fear they may do something that might hurt your benefits, and they surely don’t want to do that. So, make sure you work with someone who is an expert at how TRICARE for Life, VA Benefits and Medicare work together. This way you can rest assured you made the right decisions.
If you’re in Florida, Texas or South Carolina, YourCareRep.com can answer all your questions and help you with any needs you may have. We also have a network of agents in almost all 50 states, so if you don’t know who to speak with, reach out to us. We will be happy to connect you with a qualified agent who can help you.
