TRICARE + Medicare Advantage Plans?

Can TRICARE and Medicare Advantage Plans Work Together?  Vets with TRICARE coverage were bombarded with TV ads during AEP. They were instantly attracted to the Supplemental Benefits of MAPD and started calling their agents asking for advice. Universally, agents don’t know much about Tricare (we are busy trying to stay on top of Medicare rules!) Most agents default and tell their clients who have Tricare “Stay on Tricare and avoid MAPD” but that’s a failure on our part.

Combining TRICARE and Medicare Advantage Plans is Possible

There will be some extra work involved. Make sure your client understands that this may require extra time spent dealing with insurance providers and lag time for reimbursement.

In a nutshell: You can buy a MAPD but it becomes Primary. Tricare will reimburse you for the copays of your MAPD but here is the catch. You must first pay them and then file the paperwork with Humana (who administers Tricare) and wait for reimbursement. Most doctors DO NOT file for your client and many clients will be turned off with this added paperwork.

But those supplemental benefits are more attractive each year. Tricare members might do the paperwork in order to get dental, vision, massage, chiro and other great benefits MAPD offers!

Lets use billing a $25 copay to TRICARE as an example. Say the Medicare Advantage plan is used as the primary form of insurance. You may still be responsible for the $25 copay. In states like Florida, where they have a high population of veterans, they’ll be more likely to bill this copay directly to the secondary insurance provider. Remember, doctors don’t have to do this!

That’s where the headache comes in. In some states, the doctor won’t bill the secondary insurance directly and your client will have to do that themselves. With a lot of clients, the biggest hurdle will be using technology, so we’ve made it easy for you. They’ll have to go to the TRICARE website and download the form. Here is the link for the claims form: https://www.tricare4u.com/wps/portal/tdb/tricare4u/contact-us/formstricarebeneficiaryclaim%  They can put two incidents on one form. Don’t let them forget that it has to be submitted within one year of the appointment.

For more information check out https://www.tricare4u.com

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Sylvia Gordon and her sister, Rebecca, run Gordon Marketing, one of the nation’s largest Medicare FMO/NMA offices. They have a team of over 100 that train and support independent insurance agents in all 50 states. You can find Sylvia’s weekly posts on LinkedIn and the sisters Youtube channel posts 2 training videos each week. Contact Sylvia at sgordon@gordonmarketing.com or 800-388-8342.

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