tricare for life and medicare if you are retired military and eligible for tricare for life
this video is intended for you tricare for life and medicare work hand in glove my intent with
this brief video is to help you understand how tricare for life works with medicare and how to
avoid a very serious and common mistake encouraged by uninformed insurance agents if you've been
approached by an insurance agent who suggests that you purchase a medicare advantage plan to go with
your tricare please watch this video first it will be important to you so please stay tuned
hi i'm matthew claussen with medigapseminars.org my company is an independent insurance brokerage
specializing in medicare and retirement needs we help people with their medicare decisions
in virtually every state of the country we work with all medicare supplement plans and
we also work with medicare advantage plans and are licensed in 49 states and of course we also
have part dshopper.com for the medicare part d prescription drug plans our services are free to
you the consumer you don't pay us we are paid by the insurance company when we help you with your
application over the years i've often been asked to do a video on tricare for life and medicare
i've hesitated to do so because tricare for life is a government program insurance agents are not
authorized to sell tricare for life and i can only provide my opinion as a licensed agent with
over three decades of experience in the financial services industry but not as an active agent for
tricare i am not an agent for tricare while i cannot help you directly with your tricare
or champ va i can help you to understand how tricare for life works with medicare
or champ va and how to avoid a potentially serious mistake and that's what i'm going to do here
in recent years there is one insurance company that has decided to market directly to our
military veterans i won't say who they are in this video their rules and my contract that
prevent me from doing so but i will say they are a very reputable company in fact not only
do we do a lot of business with them across the country but my own group health insurance that i
selected for myself and my employees is through this company so i have high regard for them
in marketing directly to veterans and their families this insurance company has developed
volumes of training material to help individual agents understand the products and the market
unfortunately this insurance company like all insurance companies are fighting an uphill battle
in some cases it's simply a matter of agents not reading or watching the material that's
provided to them in other cases it's a battle against greed it's a battle against those who are
hungry for income and putting their commissions ahead of your health care this is a serious pet
peeve of mine and recent interactions with other medicare agents is is what's motivated me most
to make this video today my parents had tricare for life coverage my father was career navy he
and my mom have since passed and are buried together at arlington national cemetery
both of their end of life situations were very medically involved in both cases their end-of-life
care was made much easier because they had tricare for life and not a medicare advantage plan so how
does medicare work with tricare for life what i'm going to do here is provide you with a short
answer and then follow it up with more detailed and important explanations if you have tricare for
life or champ va it's my opinion and the opinion of the insurance company that i've alluded to that
you keep your tricare or champ va and keep your original medicare do not trade your medicare in
for a medicare advantage plan do not trade your tricare champ va in for a medicare supplement
and do not get a standalone medicare part d plan especially if you have champ va i believe
you cannot improve on your health care by messing with your tricare if you replace
your original medicare with an advantage plan you're actually reducing your insurance coverage
and potentially increasing your financial risk that's the short answer and that's my firm opinion
so how does medicare work with tricare for life i'm going to cover that
next more fully but before i do please i'm asking for a favor from you if you would please press the
like button below it helps you to pass this uh video along to others who are also asking about
tricare and medicare and if you know others that are also trying to figure out what to do with
their tricare please share this directly with them or post it on a message board
and also please share this video on social media if you believe that will help others thank you
so how does medicare work with tricare for life well tricare for life and champ va are
like medicare supplement plans on steroids as i go through this explanation i'm just going to use the
terms tricare or tricare for life but i also do mean champ va and i'm referring to tricare as you
age into medicare so how is tricare for life like a medicare supplement plan in order for tricare
for life to be active you must also have original medicare that is a medicare part a inpatient
coverage and medicare part b outpatient coverage original medicare becomes your primary insurer
and tricare is your secondary just like a medicare supplement plan tricare for life
is premium free you earned it the part of this that is most important and the reason i made
this video is that original medicare that red white and blue medicare card
is your primary insurer and that is what you want to keep so why is it important that original
medicare remain your primary insurer because you get to keep the benefits of original medicare
there are two benefits of original medicare that are critical to your health care quality
first with original medicare being your primary insurance you're not limited to any network
you can see any doctor or visit any medical facility in the u s or any u s territory as long
as they accept original medicare that's pretty much every doctor in every medical facility again
in the u.s or u.s territory technically i think it's 97 percent there are very few exceptions
second no insurance company can interfere with your care your medical decisions are between you
and your doctor the goal of both medicare and tricare is to cover everything that is
medically necessary your doctor does not need to get prior approval from an insurance company
you don't need to get a referral from your doctor if you wish to see a specialist
and no insurance company can stall or prevent your medical treatment based on their internal rules
all medicare decisions are between you and your doctor when you have original medicare tricare
for life and medicare work hand in glove so that your annual maximum out of pocket financial risk
is limited to near zero in fact the only expense for inpatient or outpatient services would be if
tricare approves a treatment that medicare does not now i've never seen this before and i've not
actually heard of it except for reading that but i i guess since it's in the manual it's possible
and in that case tricare will cover the service with a small potential out of pocket from you
please see your tricare benefit details for the specifics they're online on the government website
and i'm going to have a link to that below as i mentioned tricare for life is like
a medicare supplement plan on steroids in addition to the standard medicare supplement benefits
your tricare includes prescription drug coverage you do not want to get a separate medicare part d
plan in fact doing so can cause harm to your tricare especially if you have champ va so
be careful with that by the way did you know that the drug coverage you have through tricare is not
subject to the the gap the doughnut hole that is a feature of the medicare prescription drug coverage
you have no coverage gap no doughnut hole with your tricare for life prescription drug coverage
one of the enhanced benefits i like about tricare is that it offers significant
health care coverage overseas medicare only operates in the u.s and the u.s territories
some medicare supplement plans offer limited emergency coverage if you're overseas
a few medicare advantage plans do as well but that's quite unusual with them
when you have tricare for life and you're visiting or you've moved overseas tricare for life becomes
your primary insurer it's very cool so what is it that motivated me to make this video and
what is the issue that i have with some other medicare agents and medicare brokers let's
start with the primary issue many medicare focused insurance agents are struggling to make a living
others simply do not put the time and effort into understanding their insurance products
before trying to sell them insurance agents do not and cannot sell tricare
on the other hand medicare advantage plans pay the highest commissions
of any medicare product so when a person with tricare is looking for help instead of just
telling them that they're in a great plan and there's no reason to make a change agents try
to find a way to sell an advantage plan and make it look like you're gaining an insurance coverage
you're not the only thing an insurance agent can do to improve your coverage is to offer
you a dental plan now there's not much money in that so what's the sales pitch well they try to
sell an advantage plan based on what i refer to as the shiny objects and these are features of a plan
that have nothing to do with your primary health needs these can be dental benefits gym memberships
a free uber to a doctor's office or even some will have a give back of some or all of your medicare
part b premiums all of these shiny objects come with your having to give up an important part
of your primary health care coverage typically you're either going to give up your freedom to see
any doctor or your abilities to have a procedure done without permission from the insurance company
but that fact is entirely glossed over by the sales agent so the pitch usually goes
something like this the agent will tell you to switch from a medicare original medicare
to a medicare advantage plan medicare advantage plans replace your original medicare and they're
usually going to present a zero premium plan that includes some dental coverage or a gym membership
and they'll tell you that you can keep your tricare because it's still secondary coverage
but it's to your advantage because you now have dental coverage sounds good right well here's
what's not being said when you trade in your original medicare for a medicare advantage plan
you lose the two benefits of original medicare that i mentioned earlier
first you can no longer see any medical provider in the u.s as long as they accept medicare
you will now be limited to the medicare advantage plan network of providers the
providers you see have to have signed a contract to accept your specific medicare advantage plan
seeing providers out of network can be cost prohibitive or simply not allowed by the medicare
advantage plan second instead of your health care decisions being between you and your doctor it's
now the insurance company who directs your health care now that's important your doctor will have to
get permission from the insurance company for any procedure or treatment the insurance company can
deny the procedure or delay the procedure by up to two weeks i've seen this done for urgently
needed chemotherapy and and even dialysis or therapy after a stroke it could be anything
and another video i actually talked about the inspector general report
well two reports actually done by the inspector general for health and human services
the inspector general did an original report on medicare advantage plans it was published in 2018
that showed the insurance companies regularly deny service to the consumer as a tactic to increase
profits when you have a medicare advantage plan your doctor cannot perform a procedure without
their permission except in emergencies of course for other procedures the insurance company can
just say no and leave you to fight your your health care insurance coverage which they do
the inspector general then followed up that 2018 report with one just published in 2022
and guess what in the latest study they found nothing has changed the problem as they allude to
or they actually directly uh discuss in the in the report is the way that medicare compensates
medicare advantage plans incentivizes them to deny coverage that's not going to change i go
into detail why in again the other videos it's not necessary here in addition in 2021 the american
hospital association representing 5 000 u.s hospitals wrote a scathing letter to the centers
for medicare medicaid services cms who manages medicare complaining that when doctors are forced
to get prior approval for medical procedures the delay in coverage is harming the patients
often these are treatments for an aggressive cancer or the need to move from a hospital to
rehab after a stroke or an accident the medicare advantage plans are allowed to delay procedures
for up to 14 days and can then deny them as well the letter details the problem and the very real
harm it causes uh patients and i've linked that down below as well your tricare can pay some
copays or deductibles left as your obligation after a medicare advantage plan is paid a claim
however unlike when you have original medicare and tricare when you have an advantage plan
you will have to pay the claim and then submit the paperwork to tricare for reimbursement to
be clear when you have a medicare advantage plan anything that tricare would pay you must pay first
and then be reimbursed it's not automatically paid for like it is when you have original medicare
as an important side note retired veterans who have been switched from original medicare to a
medicare advantage plan are according to my talks with this insurance company are a significant
percentage of medicare complaints once they use the advantage plan and realize that their benefits
have been reduced from what they've had they often complain to medicare that they've been duped
so please go to the website again should be on your screen and linked below look for your
tri-care for life handbook for more details on on all of that that i've covered so to recap
tricare for life is designed to work hand in glove with original medicare you cannot improve on that
except to add dental coverage you can get that through tricare as well and there are literally
dozens of dental plans standalone dental plans that are available to you as well if you trade
in your original medicare a and b for an advantage plan you reduce your health care coverage and lose
the greatest benefits of medicare in addition anything that tricare would pay for you
you will then have to pay up front and submit paperwork for reimbursement in my opinion if you
come across an agent that's trying to replace your original medicare with a medicare advantage plan
run away they are either ignorant or simply care more about their commissions than your health care
if you have original medicare and tricare for life you have in my opinion the best health care
available to you in this country you can't improve on it you can only weaken it
please pass this information along to other veterans let's
put a stop to people making mistakes with their tricare for life as much as i would like to help
further please do not call my office for help with your tricare we cannot help you beyond
the opinion that i present in this video and the evidence that i've linked below
we are not authorized to work with tricare no insurance agent is
so there it is now it's your turn i make these videos for you i make them to help you make better
decisions please leave a comment below and let me know what part of this video that you found most
informative and if you have a question that i did not answer ask below i will do my best to respond
and if you've had an interaction with an agent uh trying to sell you a medicare advantage plan
to get extra dental coverage let me know below it would be interesting to hear your comments
but please go to the tricare for life website for detailed help
i hope you found this information helpful please like this video press the thumbs up for me
if you found this information useful and share it so others also can see this information
i'm matthew claassen with medigapseminars.org thank you for watching
you