Most Veterans and Tricare members are missing out on a ton of benefits simply because no one has explained how Medicare Advantage can benefit them without disrupting their VA or Tricare for Life benefits and without costing a dime.
First things first - having Parts A and B of Medicare is necessary to qualify for a Medicare Advantage plan. I know what you're thinking....I've got everything covered at no cost already and I like the services I receive and I don't want to mess anything up.
Tricare and VA are different, so let's address them separately. Each stands to save hundreds of dollars per year, so be sure to read to the end! Ok, ok. I'll give you a hint. Have you heard of the Part B Giveback or Part B Reduction? That alone can add up to $600-$900 per year back into your Social Security Check.
Veterans using VA
Some Veterans love using the VA for their healthcare and others can't stand it. For 17 years, I've been listening to all of the good and all of the bad. The great news is - it's 100% your choice.
If you do have A and B of Medicare and use the VA for your care, let me share some real experiences from our members. As I go through these, it's not to negate the wonderful services that the VA provides, rather it's to highlight that there are times when veterans need non-VA care and plain old Medicare doesn't offer enough coverage.
In most cases, if you visit a non-VA Emergency Room or go for a thrill ride in an ambulance, the VA will pay for that. But not always. Several of our veterans have experienced Medicare's 20% coinsurance for these services. Imagine 20% of a $3000 ER bill versus a flat $90 copay on an MA.
One gentleman was told by the VA that he needed an amputation. He had an MA plan and sought a second opinion outside of the VA. The outside doctor told him that he needed some lengthy wound care but would not lose his leg.
VA doesn't cover dental, and when 26% of adults 65+ have eight or fewer teeth, this is must! Some of the plans cover extractions, crowns, root canals, and dentures.
Now, if you're a Veteran who uses the VA for Primary Care and prescriptions, more than likely, an MA without Part D will work best. If you are a Veteran who uses non-VA doctors and pharmacies, and MAPD (includes Part D) will likely be your go-to option.
I saved the best for last. Almost all of the plans in our area that were designed with Veterans in mind include the Part B Giveback. It averages about $50 per month depending on the plan. What this means is that instead of seeing $170.10 for the Part B premium deducted from Social Security each month, it will reduce to $120.10. Hello extra $600 for the year!
Tricare for Life
Tricare recipients really don't need any additional insurance for the medical side of things. Medicare A & B pays primary and Tricare pays secondary. If you're using off-base doctors, however, adding a Medicare Advantage plan will add in a ton of extra benefits at no cost that you're currently paying out-of-pocket.
It's easy when you go to the doctor too. Instead of showing A&B as primary, just substitute the new MA card.
When selecting a plan, caution on a couple of points:
Never add a Medicare Advantage Plan that includes Part D Prescription Drug Coverage. You already have prescription coverage through Tricare, and adding Part D could mess things up.
Secondly, MA plans offer HMOs and PPOs. I recommend a PPO for Tricare for Life. The reason is that most PPOs offer nationwide coverage, which is similar to Tricare. Also, Tricare pays secondary to PPOs in or out-of-network. This is not the case with HMOs. That being said, if you don't need a nationwide network and your doctors are in the HMO network, it will work great for you.
Lastly, on incredibly rare occasion, a doctor might not agree to send the bill secondarily to Tricare. If that's the case, you will need to submit the reimbursement form yourself. Truly, in all my time as an agent, none of my Tricare members have ever been asked to do this.
Did I mention that you're going to get the extra $600 per year also? Most of the plans that work well for Tricare members include the Part B Giveback. Hooray!
Finding more info
People often seem skeptical when I explain this to them. I recommend asking veteran friends who have these plans what their experience has been. Secondly VSO officers or Tricare should be able to confirm the information in this blog.
Integrity Insurance agents are tenured and independent brokers. We strive to be Friendly, Ethical, Reliable, Informed, and Strategic. Visit our site to learn more at insure-integrity.com/medicare-va and insure-integrity.com/medicare-tricare.