I'm a business office manager of a nursing home...and I like to let folks know that while there are perks to the advantage plans...they can really limit the skilled nursing care you will get. They will say you still have 'up to 100 days'...etc..etc..however, most people get about 2 weeks of skilled nursing care approved...then the services are cut by the managed plan...whereas if you had traditional Medicare...you can be treated longer.
Another thing to consider is if you go with a managed plan...but later want Traditional Medicare plan and a supplement...you may not be able to get the supplement or have to have additional underwriting...whereas if you go with Traditional Medicare first and the supplement...you won't be turned down for the supplement. VERY important. I'm totally a traditional Medicare fan...
Very good point! However, someone who has TRICARE For Life, which is what this video is referencing would not need a supplement plan. Therefore, they would not have the concern about having to go through underwriting to get a supplement if they are sick. There TRICARE For Life is acting as their Medicare Supplement.
One thing you have to consider with an advantage plan is that most, if not all, will only cover you in the state for which you live in. I live in one state close to the border of another state where medical facilities are located. The area where I live is rural, and medical facilities are very limited unless I want to drive long distances to reach them. That is why i kept my traditional Medicare plan along with TFL. Also, when I was learning about Medicare and Tricare for Life, I was told in no uncertain terms that if I chose to not get Medicare part B, I would not be eligible for TFL, and I would not be able to get it later, even if I signed up for part B later. Has that changed?
In order for Tricare to turn into Tricare for Life you have to start A and B. From there, you can either stay on Original Medicare or shift to Medicare Advantage. In your case, you would want to utilized a Medicare Advantage PPO plan so you can have coverage outside of your service area. Let us know if you have any additional questions!
You can stay the way you have it now. That is the traditional way to be insured. However, there are plans that would take the place of A&B and give you money back in your social security to reduce the Medicare Part B premium of $174/ month.
Thanks for the excellent video. I'm retired Air Force on Tricare and will be turning 65 next year--2025. I'm still working and making a good income. I thought the Medicare Part B cost was based on your income? Is that correct, or is the $170 or so a flat rate for everyone regardless of income? Thanks.
Yes, Part B is based on your income. Here is the video on that- ruclips.net/video/ob_Ngd9LKTg/видео.html. However, if you want your Tricare to turn into Tricare for Life you need to start A & B at 65. The other option you may have is to get insurance through your work and delay Medicare until you retire.
The income adjustment is in addition to the base rate for Part B and is based on your Tax return's AGI from two years prior. For example, if your AGI was about $200,000, they would add approx $70 per month.
Thank you for your clear, direct explanation of the basics. Many presenters seem, intentionally or not, determined to obfuscate the basics so that every point thereafter is difficult to put in its proper place. Good luck with your business.
You can go back to Original Medicare at any time... the program that has the health underwriting is Medicare Supplements, which you do not need when you have Tricare For Life.
Yes, services have to be approved by the carrier. This is very similar to an employer based plan or under 65 marketplace plan approving services as well though.
As discussed in the video, there are pros and cons to each option. The scenario where it makes sense is if someone is looking to reduce the Part B Premium payment every month with the giveback option that some plans have. Its not a 1 size fits all option, that's why it is important to understand the pros and cons of both ways it can work.
What would help is number examples, like : individual goes to er via ambulance, gets admitted, has 6 day stay with surgery, then outpatient services etc…. What are the costs per each. I don’t actually have an example but these kinds of examples from other channels help me understand OM, Sup G, & Adv. but what about TFL?
There aren't many numbers to give you. Someone who has Medicare/ MAPD with Tricare typically will not have any out of pocket costs so long as it is approved by Medicare or the Medicare Advantage plan & Tricare.
We are seeing more and more people test out the Advantage plans with a giveback. Then if for some reason you don't like it you can go back to Original Medicare. You can set up a call here: www.medicarejoe.org/bookyourcall
I am 100% disabled veteran and I use the VA for all my medical needs. I have tricare too so that my wife is covered. Do I need part B or should we wait til my wife is 65 and get part B from her SS?
Great Question! So it would depend on if you ever wanted to use medical services outside the VA. If yes, then you're going to want to start your Part B at 65 or you will be penalized for life if not. Your situation sounds a little more unique, feel free to give us a call at 888-676-3633.
There are a lot of Medicare Advantage plans that do not have any additional premium to the Medicare Part B premium. Some plans like discussed in this video will actually reduce the Part B premium.
I currently am 66 military retired and have Medicare A&B, OHI, and TRICARE for Life. My spouse is same age working and on Medicare Part A, Employer OHI, My OHI. When she starts Medicare A&B can she also be covered by my TRICARE for Life too?
Tha is correct, it will automatically turn into Tricare For Life when she starts Part B. If you want to compare the Advantage Plan options in your area to the set up you have now you can contact us at 888-676-3633.
Bill, your spouse must be enrolled in both Medicare Part A & B to be eligible for TRICARE for Life (TFL). The Initial Enrollment Period (IEP), 7-month window before and after 65, is the best time to enroll in Part B. Once enrolled, they will be eligible for life which includes after your death (unless they divorce and remarries a non-military retiree). Traditional Medicare Part A & B and TFL is all you and your spouse need, going forward. The only coverage gaps are dental, hearing and optical vision. If you, as the retired member, applies for a VA card, you can qualify for vision and hearing benefits at minimum co-pays. Zero cost if you're disability rated and required care is in those specific areas. For scripts, the maximum copay is $11.00, regardless of the meds. For your TFL Part D equivalent, you've already got two options. 1) Your nearest military installation (Pharmacare or Numbered Medical Group), where your scripts can be requested and processed and, 2) Express Scripts. www.express-scripts.com/login/tricare
Thank you, but you should of talked about the Transition from tricare prime to tricare for life with dependence. That would have helped an age difference of your spouse
Maybe I can help. I’m retired Army with spouse and here’s how the transition is working for us. When I started receiving Medicare my Tricare automatically changed to TFL. My wife continues to get Tricare until she turns 65. At that point (as long as she’s already receiving SS), Tricare will automatically change to TFL for her as well.
it is good explain to me . I have a medi -medical but last year I was gotten from social office then i got B and D because of less credit for medicare. I joined D Atena . but its have change time ,before agent gone .so actually i did not have D. 4 month ago, socials office sent me a letter of my ssi or ritire time how much can get now What i have to doso I will visit the social office .
All depends on what’s being covered by which, but It sounds like you may have too much overlapping coverages. Give us a call and we can take a look- 888-676-3633
I would never use Medicare Advantage because you will have to pay all deductibles and co-pays yourself and then submit the bill to Tricare for reimbursement which would be a royal pain in the neck. Also your choice of Doctors is limited to those in the Medicare Advantage plan. Personally I would NEVER recommend using Medicare Advantage with Tricare For Life.
There are pros and cons to each side. However, if you prefer the convenience of not submitting for reimbursement from time to time over the savings on the Part B premium, then Original Medicare could be a great option. The purpose of this video is to outline the Pros and Cons of each so folks can see what might be best for their situation.
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I'm a business office manager of a nursing home...and I like to let folks know that while there are perks to the advantage plans...they can really limit the skilled nursing care you will get. They will say you still have 'up to 100 days'...etc..etc..however, most people get about 2 weeks of skilled nursing care approved...then the services are cut by the managed plan...whereas if you had traditional Medicare...you can be treated longer.
Thank you for your comment!
Another thing to consider is if you go with a managed plan...but later want Traditional Medicare plan and a supplement...you may not be able to get the supplement or have to have additional underwriting...whereas if you go with Traditional Medicare first and the supplement...you won't be turned down for the supplement. VERY important. I'm totally a traditional Medicare fan...
Very good point! However, someone who has TRICARE For Life, which is what this video is referencing would not need a supplement plan. Therefore, they would not have the concern about having to go through underwriting to get a supplement if they are sick. There TRICARE For Life is acting as their Medicare Supplement.
One thing you have to consider with an advantage plan is that most, if not all, will only cover you in the state for which you live in. I live in one state close to the border of another state where medical facilities are located. The area where I live is rural, and medical facilities are very limited unless I want to drive long distances to reach them. That is why i kept my traditional Medicare plan along with TFL. Also, when I was learning about Medicare and Tricare for Life, I was told in no uncertain terms that if I chose to not get Medicare part B, I would not be eligible for TFL, and I would not be able to get it later, even if I signed up for part B later. Has that changed?
In order for Tricare to turn into Tricare for Life you have to start A and B. From there, you can either stay on Original Medicare or shift to Medicare Advantage. In your case, you would want to utilized a Medicare Advantage PPO plan so you can have coverage outside of your service area. Let us know if you have any additional questions!
I have Medicare A&B with Tri Care for Life. My question is do I need to buy a Health Insurance policy also?
You can stay the way you have it now. That is the traditional way to be insured. However, there are plans that would take the place of A&B and give you money back in your social security to reduce the Medicare Part B premium of $174/ month.
Thanks for the excellent video. I'm retired Air Force on Tricare and will be turning 65 next year--2025. I'm still working and making a good income. I thought the Medicare Part B cost was based on your income? Is that correct, or is the $170 or so a flat rate for everyone regardless of income? Thanks.
Yes, Part B is based on your income. Here is the video on that- ruclips.net/video/ob_Ngd9LKTg/видео.html. However, if you want your Tricare to turn into Tricare for Life you need to start A & B at 65. The other option you may have is to get insurance through your work and delay Medicare until you retire.
The income adjustment is in addition to the base rate for Part B and is based on your Tax return's AGI from two years prior. For example, if your AGI was about $200,000, they would add approx $70 per month.
Thank you for your clear, direct explanation of the basics. Many presenters seem, intentionally or not, determined to obfuscate the basics so that every point thereafter is difficult to put in its proper place. Good luck with your business.
Thank you for the comment! Unbiased education is always best!
Can you switch back to original Medicare at any time if you chose advantage plan in the beginning? Or do you have to get medically approved? Thx
You can go back to Original Medicare at any time... the program that has the health underwriting is Medicare Supplements, which you do not need when you have Tricare For Life.
Is it true that under an advantage plan, the insurance company can delay or deny some treatments proposed by my doctor?
Yes, services have to be approved by the carrier. This is very similar to an employer based plan or under 65 marketplace plan approving services as well though.
In what scenario would you ever advise a veteran with original medicare + tricare for life to enroll in a Medicare Advantage plan?
As discussed in the video, there are pros and cons to each option. The scenario where it makes sense is if someone is looking to reduce the Part B Premium payment every month with the giveback option that some plans have. Its not a 1 size fits all option, that's why it is important to understand the pros and cons of both ways it can work.
The best explanation I have scene
What would help is number examples, like : individual goes to er via ambulance, gets admitted, has 6 day stay with surgery, then outpatient services etc…. What are the costs per each. I don’t actually have an example but these kinds of examples from other channels help me understand OM, Sup G, & Adv. but what about TFL?
There aren't many numbers to give you. Someone who has Medicare/ MAPD with Tricare typically will not have any out of pocket costs so long as it is approved by Medicare or the Medicare Advantage plan & Tricare.
What if I have FEHB and Tricare and I am currently 64. What is the best strategy for when I am eligible for Medicare?
We are seeing more and more people test out the Advantage plans with a giveback. Then if for some reason you don't like it you can go back to Original Medicare. You can set up a call here: www.medicarejoe.org/bookyourcall
Hello my name is Mary and I wanted to know if I should also sign up for champ VA with my Medicare as a Wife of a 100% disabled Veteran?
I believe you have to have Part B for Tricare for Life to pay as a Secondary
Yes you have to enroll in Part B, but as I explain in the video there are special plans that get you that Part B money back.
I am 100% disabled veteran and I use the VA for all my medical needs. I have tricare too so that my wife is covered. Do I need part B or should we wait til my wife is 65 and get part B from her SS?
Great Question! So it would depend on if you ever wanted to use medical services outside the VA. If yes, then you're going to want to start your Part B at 65 or you will be penalized for life if not. Your situation sounds a little more unique, feel free to give us a call at 888-676-3633.
With an advantage plan, don't you also have either copays or coinsurance?
Not when It is paired with Tricare. Tricare sits in the background and acts as a secondary to the advantage plan.
Isn't there a premium for a Medicare Advantage plan? Wouldn't that figure into the overall cost?
There are a lot of Medicare Advantage plans that do not have any additional premium to the Medicare Part B premium. Some plans like discussed in this video will actually reduce the Part B premium.
I currently am 66 military retired and have Medicare A&B, OHI, and TRICARE for Life. My spouse is same age working and on Medicare Part A, Employer OHI, My OHI. When she starts Medicare A&B can she also be covered by my TRICARE for Life too?
Yes. If you have tricare for her it will automatically turn to tricare for life when she applies for Medicare part B.
Tha is correct, it will automatically turn into Tricare For Life when she starts Part B. If you want to compare the Advantage Plan options in your area to the set up you have now you can contact us at 888-676-3633.
No I don’t. I got TRICARE for Life via military retirement and hitting age 65. We previously were not enrolled with TRICARE.
Bill, your spouse must be enrolled in both Medicare Part A & B to be eligible for TRICARE for Life (TFL). The Initial Enrollment Period (IEP), 7-month window before and after 65, is the best time to enroll in Part B. Once enrolled, they will be eligible for life which includes after your death (unless they divorce and remarries a non-military retiree). Traditional Medicare Part A & B and TFL is all you and your spouse need, going forward. The only coverage gaps are dental, hearing and optical vision. If you, as the retired member, applies for a VA card, you can qualify for vision and hearing benefits at minimum co-pays. Zero cost if you're disability rated and required care is in those specific areas. For scripts, the maximum copay is $11.00, regardless of the meds. For your TFL Part D equivalent, you've already got two options. 1) Your nearest military installation (Pharmacare or Numbered Medical Group), where your scripts can be requested and processed and, 2) Express Scripts. www.express-scripts.com/login/tricare
Thank you, but you should of talked about the Transition from tricare prime to tricare for life with dependence. That would have helped an age difference of your spouse
Maybe I can help. I’m retired Army with spouse and here’s how the transition is working for us. When I started receiving Medicare my Tricare automatically changed to TFL. My wife continues to get Tricare until she turns 65. At that point (as long as she’s already receiving SS), Tricare will automatically change to TFL for her as well.
This is 100% accurate!
@@aukfan33 That true only if your wife is younger than you.
it is good explain to me . I have a medi -medical but last year I was gotten from social office
then i got B and D because of less credit for medicare. I joined D Atena . but its have change time ,before agent gone .so actually i did not have D.
4 month ago, socials office sent me a letter of my ssi or ritire time how much can get
now What i have to doso I will visit the social office .
We'd be happy to see if we can help you with your situation. Give us a call at 888-676-3633.
Does Tricare for Life provide dental coverage?
Typically the Medicare Advantage plans would offer the dental benefit that goes with Tricare for Life.
Should I drop Blue Cross and Blue shield, since I have VA , Tricare?
All depends on what’s being covered by which, but It sounds like you may have too much overlapping coverages. Give us a call and we can take a look- 888-676-3633
If a person chooses Medicare advantage and chooses Humana as their provider wouldn't they have a premium to pay with that provider?
No, a lot of the Medicare Advantage plans specific for Tricare for Life eligibles actually reduces the Medicare premium as stated in the video.
$164.90 plus taxes taken out, doesn't leave you with much.
This is why many folks go with the Part B Giveback options available to ChampVA and Tricare recipients.
I would never use Medicare Advantage because you will have to pay all deductibles and co-pays yourself and then submit the bill to Tricare for reimbursement which would be a royal pain in the neck. Also your choice of Doctors is limited to those in the Medicare Advantage plan. Personally I would NEVER recommend using Medicare Advantage with Tricare For Life.
There are pros and cons to each side. However, if you prefer the convenience of not submitting for reimbursement from time to time over the savings on the Part B premium, then Original Medicare could be a great option. The purpose of this video is to outline the Pros and Cons of each so folks can see what might be best for their situation.
Most Dr's want referrals before accept you even if you have Tricare for Life
Some will, yes. It really depends on the doctor.
Both DO NOT cover chiropractic care
Thanks for the comment!