(dramatic music) – When you are speaking with
a TRICARE For Life individual, you want to remember what
they have already, all right. So what they have when they say they have TRICARE For Life, that means they have Medicare. A lot of people when you ask them, "What kind of insurance do you have?" They say, "I have TRICARE For Life," or "I have Federal Blue Cross." That doesn't necessarily
mean that's wrong, it just means that they have Medicare infront of those benefits.
So they have Medicare as their primary, and these entities have
their benefits wrapped around those Medicare benefits. Which means that, if
they go to the provider, and they show just their Medicare card, and they don't show their secondary card of their military ID, or
their Federal Blue Cross, Medicare will send the co-insurance or the payment that's due to the provider, that's the member's responsibility. Medicare will send that
portiotn to Tricare For Life or to the federal BlueCross BlueShield. They– – [Vicki] Just like it
would with a med sup. – Just like it would with a med sup. – [Vicki] So is TRICARE
for life, a med Sup? – No, but it is designed
as a secondary to Medicare so that if Medicare approves the cost, TRICARE for life will
also approve the cost.
– [Vicki] And who can admit a
TRICARE for life members See, do they have Is there a military network? – They can see anybody
at the federal hospitals but they can also see, any provider that's
accepting Medicare patients. – [Vicki] How is, if they want the Medicare
Advantage supplemental benefits. What happens to primary
who becomes secondary? – Okay, so if a member enrolls into a Medicare Advantage plan. Then, a member with
TRICARE for life enrolled into a Medicare Advantage plan will need to make sure that when they go to seek care at a provider's office, they use their member ID card
and their military ID card, so that their Medicare
Advantage plan becomes primary.
And then that provider needs to know that they have a secondary which is through the
TRICARE for life benefit. So that's who's first their
primary is Medicare Advantage. Secondary is Medicare, I'm sorry is your TRICARE
for life benefits. Keeping in mind that the
reason why it's important for a TRICARE for life beneficiary to understand who pays
first and who pays second, is because they are changing
their traditional Medicare A and B for a Medicare Part C. Medicare Part C does not, coordinate those benefits
on behalf of their member. They don't send the portion of the bill that's due to a provider. Medicare Advantage plans do not send that to TRICARE for life on
behalf of the member. – [Vivki] But the provider might? – But the provider might, but when a Medicare person
has TRICARE for life. Medicare will send that
portion of the payment due, to TRICARE for life on
behalf of that beneficiary. – [Vicki] Yes, so Medicare coordinates with TRICARE for life. Medicare Advantage does not. If a provider asked for the CO payment and that providers not willing
to accept the assignment and do that billing for
the patient or the member, then that member will
experience out of pocket costs.
– [Vicki] Let's say that
the members in the hospital for three overnights and has to pay 1200 dollars out of pocket? – Right. – [Vicki] He has to pay it and then he has to seek
reimbursement from Wisconsin? – That would be one way. That's not necessarily
all the way all the times, a lot of times, the provider will accept that assignment where they
will do the first billing to the Medicare Advantage plan, wait for that explanation of benefits and then do the secondary billing to the TRICARE for life administrator, which is Wisconsin physician services. They do that, they even do that for the prescription drug cost or coverage through their Express Scripts. If they use Walgreens as a
national participating provider. They will do that coordination of benefits with Express Scripts too, so, that means that they could
use Medicare Advantage for both their primary medical as well as their Part D
prescription drug coverage.
But they have to be aware of how the coordination
of benefits is arranged, because they are ultimately
responsible for it all. I think it's very important
for insurance agents to not presume what the person that has TRICARE for life benefits needs. I think that if they, first that they have the right to understand and know what the difference between Medicare and
Medicare Advantage is. That's what you're doing.
You need to let them know, here's what you can get
under Medicare Advantage. Here's what you have under Medicare, let that person make the decision on if that extra coordination in the back room has to happen, and that member might have to take a further step than
they are doing right now, don't presume that that's
not worth it to that member. – [Vicki] And that's
what a lot of agents are.
They're like, you're not gonna do this. – That's right. – [Vicki] It's paper work, it's worth. – They presume. – [Vicki] It's not worth
the extra benefits. – That's right. – [Vicki] And the extra
benefits are so attractive. – And sometimes it's not
just the extra benefits, is the support that a
Medicare Advantage plan actually presents over Medicare. If you think about the reason why you sell Medicare Advantage plans to people over Medicare Supplements, it is because of their need. They might need that extra support that a Medicare Advantage plan does, whether it's preventive, whatever it's care coordination because you went to the hospital and now you need skilled nursing and then you need home
health, physical therapy, and you wanna make sure that
all those dots are connected.
That's a Medicare Advantage plan need, and that might be something somebody needs and they have TRICARE for
life to cover their cost. (upbeat music).
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