TriCare For Life and Medicare Advantage – will this relationship work?

Most agents shy away from prospects who have retired from the military because of a lack of knowledge about TriCare For Life (TFL). With the introduction of rich and exciting supplemental benefits to Medicare Advantage plans, many military retirees are calling and asking agents questions the agents are not prepared to answer. Here is a little cheat sheet for you when that call comes:

What to know

TFL has a network and cost shares and a monthly premium, albeit very small. Think of TFL as a Medicare Supplement as it supplements Medicare so the member has wrap around coverage. There is never a reason to purchase a Medicare Supplement—but MAPD is attractive. Military retirees are swayed by the addition of dental, vision, hearing, transportation, acupuncture, massage, chiropractic and of course, that sweet OTC money each quarter!

What happens when a TriCare For Life member enrolls into a MAPD?

First, let’s back up. Humana and United Healthcare designed MA only plans specifically for this population. MA only allows the member to keep their TFL Rx benefits, which are priced much more attractively than Part D plans. Yes, you could sell a MAPD, and the retiree could get reimbursed for his PDP copays, but that requires the member to file a claim for reimbursement with Express Scripts (the TFL pharmacy).

Paper work is never fun, but that is the hurdle you are dealing with. If a TFL member purchases a MA plan, TFL becomes the secondary payor. What cost shares the member has on the MA plan can be reimbursed by TFL if the member files the paperwork. The member has 12 months to file and can send a bunch of claims in at the same time. It’s really not as bad as it sounds, but we all know some clients will not have the patience to do it. When you fully understand this hurdle and your client is fine with the extra work in exchange for the extra benefits, it is a good option.

Keep in mind that once your client purchases a MA plan it becomes primary and he is subject to the cost shares on the MA plan. Translation: he’s got to pony up the money first and then seek reimbursement. If this isn’t a problem, selling Advantage plans to TFL members is a good option.

 

For more information about TriCare For Life  click here.

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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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