As most Medicare insurance professionals know, learning and understanding the complex health coverage system is no small feat. There are countless rules, exceptions and legal guidelines for how Medicare plans should be enrolled and administered. One question that frequently comes up for agents is: If your client is a veteran who is on Tricare, can you also enroll them in Medicare? Can you combine Medicare and Tricare?
The short answer is yes, but you need to understand how Medicare and Tricare interact before you can be sure you’re selling your veteran clients the best fit plan for them.
How do you combine Medicare and Tricare?
The relationship between Medicare and Tricare is complex. When you combine Medicare and Tricare, the degree to which they interact depends on factors like military status. Here’s what you need to know about how Tricare affects your Medicare beneficiaries’ coverage options based on their current service status.
Active duty beneficiaries who are already enrolled in Medicare Part A don’t need to enroll in a Medicare Part B plan to retain their Tricare coverage. But if your client is waiting for a decision on medical retirement, advise them to keep their Medicare Part B. This way they don’t have a lapse in Tricare coverage when they retire.
Spouses and dependent family members of active duty beneficiaries who are eligible for Medicare Part A don’t have to get Medicare Part B to keep their Tricare coverage. However, once their sponsor retires, they have to enroll in Medicare Part B to supplement their Tricare plan.
Retirees and their families eligible for Medicare Part A need to secure Medicare Part B coverage to retain their Tricare plan. This includes retirees and their families who live overseas.
A client who fails to enroll in a Medicare Part B plan or drops their Medicare Part B plan risks losing their Tricare coverage. So make sure your eligible clients select, enroll and pay for a Part B plan to avoid a lapse in their Tricare benefits!
Beneficiaries enrolled in Tricare Reserve Select or Retired Reserve
Clients in this group who are eligible for Medicare Part A don’t have to get Medicare Part B to enroll in Tricare Reserve Select. But it’s strongly encouraged!
When clients use Tricare as their primary health insurance, they’re regarded as active duty family members. Strangely, Medicare doesn’t consider the actual veteran as actively employed by the military. So if a client fails to enroll in Medicare Part B when they’re first eligible, they may be forced to pay a Medicare Part B Late Enrollment Penalty. But your client can avoid this penalty if you advise them correctly, and they follow through, on enrolling in a Part B plan from the start.
Beneficiaries enrolled in the U.S. Family Health Plan
If one of your clients is enrolled in the U.S. Family Health Plan, they are classified the same as if they were enrolled in Tricare’s Reserve Select of Retired Reserve. And with this plan, getting a Medicare Part B plan to supplement existing coverage is a great idea!
Sometimes clients need to unexpectedly disenroll from the U.S. Family Health Plan because of a move or other unforeseen circumstance. In that case, having a Part B plan as a backup is a useful way to make sure they don’t experience a lapse in Tricare benefits.
What about Medicare Advantage Plans?
Tricare and Medicare Advantage (MA) Plans can be combined. Unfortunately, this combo usually results in quite a bit of time spent haggling with the insurance company and delayed reimbursements. But if your client really likes their MA plan, combining it with Tricare could be worth their while.
Beneficiaries with Tricare and MA must use MA as their primary insurance. Copays and other expenses are paid upfront and out-of-pocket. The beneficiary then has to submit the appropriate paperwork to Humana for Tricare to reimburse these expenses. Most doctors won’t do the paperwork for them.
However, these reimbursements could cover anything from dental care to chiropractic work. So investing some time and effort on paperwork to recoup these fringe benefits could be worth the effort.
Learning how Tricare and Medicare can work together is an important step to serving your veteran clients successfully. If you still have questions about Medicare and Tricare, contact us at firstname.lastname@example.org or email@example.com.
image credit: shutterstock/Steve Cukrov