Over the years I have often been asked to do I video and write a blog post on how Medicare works with Tricare for Life. I have hesitated to do so because TRICARE for Life is a government program. Insurance agents are not authorized to sell TRICARE for Life Insurance. I can only provide my opinion as licensed agent with over three decades of experience in financial services. I am not an agent of TRICARE for Life.
While I cannot help you directly with your TRICARE or ChampVA, I can help you to understand how TRICARE for Life works with Medicare, or ChampVA, and how to avoid a potentially serious mistake. That is what I am going to do here.
In recent years there is one insurance company that has decided to market directly to our military veterans. 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, they are fighting an uphill battle. In some cases, it is simply a matter of agents not reading or watching the material that is provided to them. In other cases, it is a battle against greed. It’s a battle against those who are hungry for income and putting their commissions ahead of your healthcare.
This is a serious pet peeve of mine and recent interactions with other Medicare agents is what has motivated me most to write this post today. My parents had TRICARE for Life coverage. My father was career Navy. He and my mom have 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.
How Does Medicare Work with TRICARE-for-Life?
What I am going to do here is to provide you with a short answer, then follow it up with a more detailed and important explanation.
If you have TRICARE for Life or ChampVA it is my opinion and the opinion of the insurance company to which I have alluded, that you keep your TRICARE or ChampVA, and keep Original Medicare. Do not trade your Medicare in for a Medicare Advantage Plan, do not trade your TRICARE or ChampVA in for a Medicare supplement, and do not get a stand-alone Medicare Part D plan.
I believe you cannot improve on your healthcare by messing with your TRICARE. If you replace your original Medicare with an Advantage plan you are actually reducing your insurance coverage and increasing your financial risk.
That’s the short answer. That’s my firm opinion.
Tricare For Life is Like a Medicare Supplement
For TRICARE for Life to be active, you must also have original Medicare. That is Medicare Part A (inpatient coverage) and Medicare Part B (outpatient coverage). Original Medicare becomes your Primary insurer and with Tricare being 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 insurance.
Why is it important that original Medicare remain your primary insurance? Because you get to keep the benefits of original Medicare.
There are two benefits of original Medicare that are critical to your healthcare.
First, with original Medicare being your primary insurance, you are not limited to any network. You can see any doctor or visit any medical facility in the country as long they accept original Medicare. That’s pretty much every doctor and every medical facility in the US. or US territory. 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 the insurance company. You do not need to get a referral from your doctor if you wish to see a specialist. No insurance company can stall or prevent your medical treatment based on their internal rules. All medical 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. I have never seen that, but I guess it’s possible. In that case TRICARE will cover the service with a small potential out-of-pocket from you. Please see your TRICARE benefit details online for specifics. I have a link to the government site below.
Do I Need Medicare Part D with Tricare for Life?
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 ChampVA.
By the way, did you know that the drug coverage you have through TRICARE is not subject to the expensive coverage gap that is a feature of Medicare Prescription drug coverage? You have no coverage gap, no donut hole like those with Part D have to deal with.
Tricare For Life & International Coverage
One of the enhanced benefits I like about TRICARE is that it offers significant healthcare coverage overseas. Medicare only operates in the US and US territories. Some Medicare supplement plans offer limited emergency coverage if overseas. When you have TRICARE for life and are visiting or have moved overseas, TRICARE becomes your Primary Insurance for overseas healthcare. Very cool.
Beware the Medicare Advantage Sales Pitch
So, what is it that motivated me to make this video and what is the issue with I have with some other Medicare agents or 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 selling 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 they are in a great plan some agents try to find a way to sell an Advantage Plan and make it look like you’re gaining in insurance coverage. You are not.
The only thing an insurance agent can do to improve your coverage is to offer you a dental plan. There is not much money in that.
So, what is the sales pitch? Well, they try to sell a Medicare Advantage plan based on what I refer to as Shiny objects. These are features of a plan that have nothing to do with your primary health needs. These can be dental benefits, gym membership, free uber to a doctor’s office, or even a give back of some of your Part B premium. All these shiny objects come with your having to give up an important part of your primary healthcare coverage. But that fact is entirely glossed over by the sales agent.
The pitch usually goes something like this; the agent will tell you to switch from original Medicare to a Medicare Advantage plan. Usually a zero premium plan that includes some dental coverage or gym membership. They will tell you that you can keep your TRICARE because it is still secondary coverage, but it’s to your advantage because you now have dental coverage.
Sounds good, right? Here is what is NOT being said.
When you trade in your original Medicare for a Medicare Advantage plan, you lose the two benefits of original Medicare I mentioned earlier.
First you can no longer see any medical provider in the US as long as they accept Medicare. You will now be limited to the Medicare Advantage plan network of providers. Seeing providers out of network can be cost prohibitive or simply not allowed by the Advantage Plan.
Second, instead of your healthcare decisions being between you and your doctors, it is now the insurance company who directs your healthcare. That is 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 have seen this done for urgently needed chemotherapy and even dialysis and organ transplants.
If you would like to know even more about the disadvantages of Medicare Advantage Plans, please see my article titled “Disadvantage of Medicare Advantage“.
The Inspector General Report on Medicare Advantage Plans
In another article I talk discuss the Inspector General Report, two reports actually. The inspector general for Health and Human Services did an original report on Medicare Advantage Plans 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 for your health insurance coverage.
The Inspector General then followed up that 2018 report with one published in 2022. In the latest study they found nothing has changed. The way that Medicare compensates Medicare Advantage Plans incentivizes them to deny coverage. That is not going to change. I go into detail why in the other video.
In addition, in 2021 the American Hospital Association representing 5,000 US Hospitals, wrote a scathing letter 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 aggressive cancer or the need to move from a hospital to rehabilitation after a stroke or an accident. The Medicare Advantage Plans are allowed to delay procedures up to 14-days and then can deny them as well.
The letter details the problem and the very real harm it causes patients.
I have linked all of this below.
Your TRICARE can pay some copays or deductibles left as your obligation after a Medicare Advantage plan has paid a claim. However, unlike when you have original Medicare and TRICARE, with an Advantage plan you will have to pay the claim and submit 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 reimburse. It is not automatically paid for like it is with Original Medicare.
As an important sidenote, retired veterans who have been switched from Original Medicare to a Medicare Advantage are a significant percentage of Medicare complaints. Once they use the Advantage plan and realize their benefits have been reduced from what they have, they often complain to Medicare that they have been duped.
Please go to https://www.tricare.mil/Publications and look for your TRICARE for Life handbook for more details on all that I have covered.
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.
If you would like to look at some stand-alone Dental Plans, take a look at the plans in these two links. They are among my favorites.
Ameritas: https://myplan.ameritas.com/id/010S4605
Protector Plus: https://myplan.ameritas.com/ppd/id/010S4605
Anyway, if you trade in your original Medicare A & B for an Advantage Plan, you reduce your healthcare coverage and lose the greatest benefits of Medicare. In addition, anything that TRICARE would pay you, you will have to pay upfront and submit paperwork for reimbursement.
In my opinion, if you come across an agent that is trying to replace your original Medicare with a Medicare Advantage Plan, run away. They are not going to improve your healthcare over the TRICARE for Life you have.
Links mentioned in the video:
Medicare Advantage Denials of Care
FAQ Changing Medicare Plans Or Companies
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
