Access to quality healthcare is crucial for individuals, especially for those who have served our country through the military. In recent years, many TRICARE beneficiaries have sought to enhance their coverage by exploring Medicare Advantage plans. In this blog post, we will explore how TRICARE for Life works with Medicare Advantage plans and things to consider before you decide.
Understanding TRICARE for Life (TFL)
TRICARE For Life is Medicare-wraparound coverage if you are TRICARE-eligible and have Original Medicare Part A and B. This means that when you receive care from an authorized provider, your claim will be submitted to Medicare. Medicare will pay it’s claim first and then send the claim to TRICARE For Life. TRICARE For Life then pays the provider directly for TRICARE-covered services. Generally, you’ll have no out-of-pocket costs for services that both Medicare and TRICARE cover. TRICARE will pick up your portion of your Medicare covered expenses, including copays, coinsurance and deductibles.
This coordination of benefits is seamless and completed between Medicare and TRICARE without any extra effort on the veteran’s part.
What is a Medicare Advantage Plan?
Medicare Advantage plans, also known as Medicare Part C, are private health insurance plans that offer an alternative to Original Medicare. These plans provide the same coverage as Original Medicare, but they can also include additional benefits. These benefits can include Part B giveback, hearing aids, coverage for wellness programs, and over the counter benefits that TRICARE for life does not.
Can you have both TRICARE for Life and a Medicare Advantage plan?
The answer is yes, but with some consideration. Many Veterans have become interested in Medicare Advantage plans because of the extra benefits they offer. However, these benefits may come with the cost of giving up some convenience around billing. Medicare Advantage plans do not coordinate billing with TRICARE the same way as Original Medicare does. This is because they are administered by private health insurance companies, and not directly by Medicare. The next section will explain how billing works between them.
How does Medicare Advantage work with TRICARE?
If you enroll in a Medicare Advantage plan, TRICARE will still pay your portion of Medicare copays, coinsurance, and deductibles. However, you will likely have to pay them up front and then submit them for reimbursement from TRICARE. If you live in a big city with a high population of seniors, you can ask your doctor to submit your claim to your Medicare Advantage plan and to TRICARE as the second payer insurance for you. However, there is no guarantee they will. If they do not, then you would submit the claim using TRICARE claims form.
The decision to get a Medicare Advantage plan depends on personal preference. Do you want the extra benefits if it could mean submitting copays and coinsurance for reimbursement to TRICARE?
Don’t have TRICARE for Life but still have Veterans Benefits? Learn more about How Medicare works with Veterans Benefits.