My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdraw?

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anders37
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My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdraw?

Post by anders37 »

I assist my mother with her finances, health care (appointments and records), etc. She has memory challenges, but knows that she has Tricare for Life from her late husband's career in the military and she is grateful since it covers just about everything 100%.

Last open-enrollment season, United Healthcare/AARP Medicare Advantage got to her and she signed up. She doesn't need the $$, but she was swayed by the fact that she would get $50 more per month in her SS check (they essentially paid her to take it) because (I guess) she has/had a zip code where the premiums were negative and were rebated.

Her Medicare Advantage plan has been in "first position" in terms of her coverage this last year with Tricare for Life in second. She has been well this year so I haven't had too many chances to check that it's all working, but I have been aware of Tricare for Life paying $5 that wasn't covered by Med Advantage a couple of times, so I guess it IS working on the day-to-day stuff.

As her right-hand woman, DPOA, trustee on her revocable trust, I would rather just give up the extra $50/month and have her on Tricare for Life only, but maybe I'm being silly (I'm haunted that if she needs hospitalization or a care facility that she would have to be limited to what the Med Advantage plan allows.) United Healthcare/AARP have been calling her a lot lately to come do a "home visit" (purportedly one of their "benefits") and I know they will be seeking to renew her (or I imagine they will). IS THERE INDEED A POTENTIAL PITFALL to having this Med Advantage plan in first position over her deluxe Tricare for Life coverage? Or is it no big deal and should I just stand back and let her have the "fun" of getting the rebate from them and enjoying their few hundred dollars a year of vision and dental (that Tricare for Life does NOT cover)?
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TierArtz
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by TierArtz »

I've not personally crossed the Medicare bridge yet, but your question inspired a bit of research.

From what I understand, Tricare is offered in various plans for eligible individuals under age 65 (I'm covered by a common one). But, when one turns 65, one must enroll for Medicare Parts A (free) and B (income based); then, one automatically becomes enrolled in Tricare for Life (assuming the Defense Department has the right information on the person). Medicare Parts C (Medicare Advantage plans) and D (Prescription Plan) are not required.

Irrespective of all the options, Medicare will always be in "first position", and TFL kicks in under some circumstances. I have much to learn in the coming years.

This Tricare webpage may be helpful: https://tricare.mil/LifeEvents/Medicare
runner3081
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by runner3081 »

Does her current medical care team and all specialists take the Advantage plan?
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celia
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by celia »

Is Tricare for Life free for her?

Does either plan cover drugs? If so, can both plans be used on the same Rx?


My guess is that there will not be good coordination between the plans. Most Medicare Advantage plans are HMOs requiring a co-pay for each visit. They don’t bill Medicare (because they’ve agreed to cover the entire bill). I also don’t think they generate Explanation of Benefits. So if something is not covered, I suspect they will bill the patient instead of Tricare for Life. And without the codes for the diagnoses and services provided, the patient won’t be able to forward the remaining part of the bill to Tricare.

Why don’t you call her HMO group and talk to billing. Explain that you are helping your mom with her bills. (Mom will have to be nearby to give permission for you to speak on her behalf.) Then ask if anything was not covered since she joined. How much did she spend out of pocket? How do they co-ordinate with Tricare for Life?

It may be possible for her to spend more than $50 a month and have confusing bills. In the long run, it is probably worth giving up the $50 to simplify her and your lives. Or she can pick an HMO group far away that she will never visit. Just use Tricare for all doctor and hospital visits. But use the HMO for vision, dental, hearing, gym, transportation benefits, etc.

You asked an interesting question. Note that my response was based on knowing Medicare, Medicare Advantage, Medigap (Supplemental plans), and Medicare drug plans. Tricare is not something I’ve worked with yet in my set of elderly relatives.
lgerla
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by lgerla »

My husband is on Tricare for Life, and it is excellent. (I am not yet on Medicare but will have it also).

The main pitfall, as I see it, is access to her established doctors or specialists she may need in the future. All Advantage plans are HMOs and her doctors may be in it this year, but maybe not in another year, whereas with TFL as a secondary payer, the doctor would have to forego all Medicare patients to no longer participate.

The second pitfall is that it may not always be free or rebated - that can change every year.

Tricare for Life is an earned benefit! It also may be changed in the future, but for now it is the best there is.

The marketing on all supplement, but even more so with Advantage plans, is very sophisticated. It would be great if there was a way to block them access to TFL recipients. WORST of all, my husband was actually fraudulently switched to an Advantage plan a year ago - it was not even open enrollment, and he received a "Welcome" package in the mail detailing his new benefits. It was done by a phone call with the caller claiming he had moved - and that is a valid reason for switching mid-year. The new address given was not even a postal address. As a software designer, I was incredulous that the registration software did not even have an address verification tool to prevent it. He was reinstated to Medicare/TFL within a few weeks, but had to get a new Medicare number as his was obviously compromised. As a Moffitt Cancer Center patient, he could not afford to lose access to the doctors who have saved his life! Tricare for Life paid 100% of his treatment claims.

I would check your online portal for Tricare for Life to see what claims were paid this year. You can also call as I have found the customer service to be excellent. Check with her current doctors (especially ones she may not have seen this year) or look at the Advantage provider list to see if they are in it. Find out if she could get the best medical care she could find if she needs it (such as specialized cancer center) under the plan. Those are all reasons to stay with Tricare for Life.
oaoaoa
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by oaoaoa »

Hi, short version: from an access and financial standpoint the advantage plans are not good compared to the combo of plain old Medicare and tricare.

Long version: I’m a physician in a surgical sub specialty and see what happens to patients with regular tricare/Medicare and those w advantage plans. The bottom line is those with advantage plans are sometimes denied services that those with regular plans are allowed. Further, some surgical services require prior auth and that takes time while those on regular tricare/Medicare don’t. Finally, look at the potential total maximum financial annual outlay in a worst case scenario. You’ll find she’ll end up paying more while on the advantage plan. Many of my patients switched back to regular Medicare when they discovered this fact.
billfromct
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by billfromct »

Each state has a “State Healthcare Insurance Assistance Program” (SHIP, I guess they leave out the ‘A’ in the abbreviation to make it easier to remember) that you can call & they can provide unbiased information on Medicare & private insurance programs tied to Medicare in your state.

Of course all those Medicare Advantage advertisements on TV claim their plan covers “eye glasses, hearing aides, rides to doctor visits, gym membership, free meals, free pizza on Friday night…”, well maybe I made up the free pizza on Friday night but you get the picture. They promise everything to get you enrolled.

One thing the advertisements don’t mention is the “out of pocket” maximum costs. Your state SHIP may be able to explain this.

I don’t have a Medicare Advantage plan; I have a Medicare Supplement/Medigap plan which basically pays for everything, co-pays, Medicare out of pocket costs, etc., but no free pizza on Friday night.

bill
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calmaniac
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by calmaniac »

My wife has TFL, I am still a year away. I am a physician and have decided MA makes no sense for us.

For most patients, Medicare Advantage does not make sense for someone on TFL. It limits your choice of physicians and hospitals, with minimal upside. There are some great HMOs like Kaiser, but others that don't have the value of a true HMO with unified healthcare like Kaiser.

Some additional thoughts:
1. If you are the primary caregiver, the added complexity and hoops to run through with MA will likely take more of your time and energy.
2. TFL already has an excellent drug plan included. Does that get downgraded with MA?
3. How old is your mother and how much medical care does she consume? May not be a big issue now, but could blow up in the future.
4. MA may be particularly limited in smaller cities, where HMOs have limited resources that are physically distant.
"Pretired", working 20 h/wk. AA 75/25: 30% TSM, 19% value (VFVA/AVUV), 18% Int'l LC, 8% emerging, 25% GFund/VBTLX. Military pension ≈60% of expenses. Pension+SS@age 70 ≈100% of expenses.
BoomerM3
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by BoomerM3 »

I have been with Tricare For Life for 20 years and I never regret not going with another plan. I choose my own doctor; don't need referrals; and don't see any medical bills. When visiting a medical facility, I feel sorry for people shelling out large copays - I have no copays.

Part of the TFL benefit is the prescription drug plan. Most of my meds are $10.00 for 90 day supply (with a few exceptions).

It's not necessarily about the money - it's a lot less hassle! You should point out to your mother that her husband served and earned this benefit. It is not something that should be ignored without considerable thought.
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by tomd37 »

Anders37,
I am a military retiree having retired in 1981 and have been eligible to Tricare for Life ever since. Actually I did not know about it until 2002 when I finally fully retired at age 65. Between 1981 and 2002 I was fully covered by my employers plan and had no need for it.

When I signed up for "Original Medicare" in 2002 Tricare for Life became my supplemental medical insurance coverage and we have never had to pay anything other than a periodic $19 eye exam charge that was not covered by either plan. As you probably know there is currently not any annual charge for Tricare for Life coverage. Their charges for prescriptions through Express-Scripts are quite low and we incurred the highest one (an inhalant) just this year at $47. We get quarterly reports from Tricare for Life for any medications prescribed. In my opinion you cannot beat Tricare for Life. :D
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celia
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by celia »

anders37 wrote: Fri Oct 22, 2021 12:16 am Her Medicare Advantage plan has been in "first position" in terms of her coverage this last year with Tricare for Life in second. She has been well this year so I haven't had too many chances to check that it's all working, but I have been aware of Tricare for Life paying $5 that wasn't covered by Med Advantage a couple of times, so I guess it IS working on the day-to-day stuff.
OP, your post sounds to me like your mom has BOTH a Medicare Advantage plan AND Tricare. Others here are responding is if you have to choose between them. If you have to choose, of course Tricare is superior.

But according to Medicare, you can only have one plan and whenever you sign up for a new one, the old one is automatically dropped. Since both of these are sponsored by the government, it makes sense you can’t double dip.

Maybe Medicare doesn’t know she also has Tricare, and she is falling through the cracks of not being seen as on two government plans. I would call both Medicare and Tricare to confirm she can be on both (and they still see her as enrolled). But somehow I think they both might say ‘no’.

But if her husband had been a life-long employee of a private company, she might have been eligible for both. But I think even most employer medical plans want you to file for Medicare when you turn 65, so they can share the claims with them.
Rex66
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by Rex66 »

Horrible decision

Definitely reverse it if possible

I’d be betting an agent did this for commission and not bc it’s better for her
Dontridetheindexdown
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by Dontridetheindexdown »

Rex66 wrote: Fri Oct 22, 2021 12:20 pm Horrible decision

Definitely reverse it if possible

I’d be betting an agent did this for commission and not bc it’s better for her
Yes, +1000

The absolute best plan for anyone over 65 who has Tricare for Life is to enroll in traditional Medicare Parts A and B.

As long as your mother visits Medicare providers, Tricare for Life will cover all co-pays and deductibles.

Whenever Medicare is billed by a provider, Medicare coordinates with Tricare, and everything is covered.

Tricare for Life also provides excellent prescription coverage, no need to buy a Medicare Part D.

Only caveat is if your mother spends considerable time outside the U.S. (including on cruise ships).

Medicare does not provide coverage outside the U.S., in which case Tricare for Life becomes primary, and coverage will be provided through the Tricare Overseas Program.
pennywise
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by pennywise »

celia wrote: Fri Oct 22, 2021 11:56 am
OP, your post sounds to me like your mom has BOTH a Medicare Advantage plan AND Tricare. Others here are responding is if you have to choose between them. If you have to choose, of course Tricare is superior.

But according to Medicare, you can only have one plan and whenever you sign up for a new one, the old one is automatically dropped. Since both of these are sponsored by the government, it makes sense you can’t double dip.

Maybe Medicare doesn’t know she also has Tricare, and she is falling through the cracks of not being seen as on two government plans. I would call both Medicare and Tricare to confirm she can be on both (and they still see her as enrolled). But somehow I think they both might say ‘no’.
This is not correct. Someone who's over 65 YO and using Tricare for Life has Medicare as their primary health insurance and Tricare is a supplement. It's not an either/or proposition.

I'm neither a doctor nor a health insurance specialist, but my father was a retired military officer who had Tricare for Life and from what I can see it's definitely the golden ticket in terms of Medicare supplementary coverage. As I understand it from what my dad explained, Tricare for Life coverage basically means any and all expenses not covered by Medicare are pre-approved to be covered by Tricare.

So there is definitely no advantage whatsoever to downgrading to a Medicare Advantage plan plus Tricare. Basically your mom has signed herself up for a more restrictive option that can and probably will end up costing her more than the $50/month she thinks she is saving.

Agree with others, get her out of that ASAP. Luckily it's open enrollment so you can take care of it expeditiously.
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celia
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by celia »

pennywise wrote: Fri Oct 22, 2021 12:47 pm This is not correct. Someone who's over 65 YO and using Tricare for Life has Medicare as their primary health insurance and Tricare is a supplement. It's not an either/or proposition.
I’m sorry for the confusion and now I see I probably added to it.

When I referenced ‘Medicare’, I meant ‘Medicare and all the parts you are eligible for because of having Medicare’. That was meant to include all the Medicare Advantage plans, all the Medigap (supplemental) plans and all the Medicare drug plans.

Tricare is not a Medicare supplemental plan. It is an employer plan where the employer just happened to be the Department of Defense.

Does my post make sense now?

I understand OP as saying her mom has BOTH a Medicare Advantage plan (so she can collect the extra $50 a month) AND Tricare for Life (as an employer supplemental plan).

I can see where it might be possible to have both, but I’m not sure. I think that is what the OP needs to find out.

This could be thought of as similar to being eligible for 2 employer plans for life for free. Pick one as your primary one and let the unpaid parts of the claims fall to the other one. They will both likely want you to sign up for Medicare at 65 too. At that point, if you are retired, your claims would be paid in this order: original Medicare, Employer plan 1, Employer plan 2.
Chip
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by Chip »

I think the OP has mentioned the ONLY possible advantage of the MA plan -- potential dental and vision benefits that TFL doesn't cover. But I suspect those benefits are tiny.

Both my parents had Medicare + TFL. After seeing their experience I can't imagine giving that up and having to deal with UHC as the primary payer. Life is too short to have to fight with them about coverage and other issues.
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by Chip »

celia wrote: Fri Oct 22, 2021 1:32 pm Tricare is not a Medicare supplemental plan. It is an employer plan where the employer just happened to be the Department of Defense.

Does my post make sense now?
No. TFL may not be one of the letter-coded Medicare supplement plans, but it acts EXACTLY like one and includes the equivalent of a Part D benefit. Walks like a duck, quacks like a duck; it's a duck. Of course the cost is an issue -- it's free. /s
RetiredAL
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by RetiredAL »

Chip wrote: Fri Oct 22, 2021 2:08 pm
Both my parents had Medicare + TFL. After seeing their experience I can't imagine giving that up and having to deal with UHC as the primary payer. Life is too short to have to fight with them about coverage and other issues.
+10 about TFL being very good. Over the last few years, my elderly Dad has been hospitalized 2 times and has had many trips to the ER.

Only 1 unexpected bill, and that was transport related, was an ambulance return trip back to his Assisted Living that was caused by the hospital not using the right return transport code. When you go to the ER on a gurney and you are able to walk, the return must be by gurney.
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anders37
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by anders37 »

OP here - THANK YOU for all these great replies. (I don't know how to reply to several contributors at a time--sorry.)

* She has had both this last year. TFL has been in first position, but the potential hassles of that have not been put to the test since she hasn't consumed much care this year. As mentioned, I see where TFL has paid $5 or $10 here or there for things that UHC did not, but it wasn't a good year to test this (thank goodness since I want her in great health).

* I talked to both TFL and UHC and apparently she is "allowed" to have both, but UHC has to be in first position. This spooks me going forward because I don't want her to be subject to their policies/ limits when we're faced with care decisions (I'm sure we could hassle and advocate and eventually get what we want through TFL, but I don't want that ball & chain at a stressful time.)

* She is 82 and I am going to insist to her that it's a false economy to let UHC in to the mix (in first position) since I want her to be administratively AGILE and streamlined if we need to suddenly get her to a specialist in our area (or large regional city 2 hours away, which is where most with a choice go for advanced procedures).

THANK YOU AGAIN TO ALL -- I will tell her she can/should celebrate the $600 extra SS and free eye exam she got this last year, but that we are breaking up with UHC and their Med Advantage plan now that it's open enrollment again :).
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celia
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by celia »

Chip wrote: Fri Oct 22, 2021 2:13 pm
celia wrote: Fri Oct 22, 2021 1:32 pm Tricare is not a Medicare supplemental plan. It is an employer plan where the employer just happened to be the Department of Defense.

Does my post make sense now?
No. TFL may not be one of the letter-coded Medicare supplement plans, but it acts EXACTLY like one and includes the equivalent of a Part D benefit. Walks like a duck, quacks like a duck; it's a duck. Of course the cost is an issue -- it's free. /s
That DOES NOT make it a Medicare supplemental plan. And it DOES NOT act as one, except for paying the bills. Medicare does not regulate or have any ‘say’ over how it is run. Whether you use it or not, Medicare does not recognize it as one of their plans. That was my whole point.

I was on a free employer plan past age 65. When it was no longer paid for by my past employer, I wanted to change to a Medicare-compliant plan but had to go thru medical underwriting and almost couldn’t find a plan that would accept me because of my medical history. Luckily, each company asks different underwriting questions and it is somewhat well-known who has easier questions (AARP United HealthCare). Once you are on one of the Medicare supplemental plans, it is easy to change to another one, if your state rules allow changes.
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celia
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by celia »

anders37 wrote: Fri Oct 22, 2021 2:59 pm * She has had both this last year. TFL has been in first position, but the potential hassles of that have not been put to the test since she hasn't consumed much care this year. As mentioned, I see where TFL has paid $5 or $10 here or there for things that UHC did not, but it wasn't a good year to test this (thank goodness since I want her in great health).

* I talked to both TFL and UHC and apparently she is "allowed" to have both, but UHC has to be in first position.
While you (or your spouse, if on spouse’s insurance) are still working, the employer insurance pays first. After you (or spouse, if on spouse’s insurance) are retired, Medicare pays first. The fact that Tricare paid so little shows that they were not billed first.

And that is a good decision to ditch the Medicare Advantage plan. I had a Medicare supplemental plan that had extra benefits I had forgotten about. One benefit was a drug discount plan. So without changing my Medicare drug plan, one day I went to pick up an on-going Rx and noticed the price had jumped. I asked the pharmacy to look at the pricing on the computer to figure out why. She said I had two drug plans (and I said I only had one) and the top-listed one processed the med, but the med was full price. So I asked her to pass it through the other drug plan instead but the pharmacy computer couldn’t handle that. After many phone calls, it was the discount drug plan interfering. BTW, the ‘discount’ was $0. This shows that sometimes those freebies make life harder.

OP, getting ‘cleanly-defined’ insurance will help you in the long run. There are more important things to spend your time on than this. (But, somehow, DH and I fall into all the unusual cases. The one we’re fighting at the moment is ‘negative’ monthly billing for a drug plan that we paid for upfront at the beginning of the year for the whole year. The negative amount we ‘owe’ is the remaining credit we still have. :oops: )
lgerla
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by lgerla »

OP,

I am very glad you understand the pitfalls of not being in Tricare for life and hope your mother will understand she has the best options using it

Celia, your understanding is not correct about TFL and about Medicare advantage. If you join a Medicare Advantage plan, you are disenrolled from Medicare. I saw this on my husband's Medicare.gov account during his foray through the fraudulent enrollment. The MA plan becomes primary and Medicare pays it per enrollee. They manage and pay for the enrollee's health care.

The OP's mother did not lose her TFL eligibility, but it essentially became worthless under MA.

Military retirees and spouses who are on Tricare before age 65, enroll in Medicare Part A and Part B upon attaining age 65. Medicare is the primary payer, and TFL takes second position. It may not be listed as a supplemental because it's only available for the military.
Chip
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by Chip »

celia wrote: Fri Oct 22, 2021 3:08 pm
Chip wrote: Fri Oct 22, 2021 2:13 pm No. TFL may not be one of the letter-coded Medicare supplement plans, but it acts EXACTLY like one and includes the equivalent of a Part D benefit. Walks like a duck, quacks like a duck; it's a duck. Of course the cost is an issue -- it's free. /s
That DOES NOT make it a Medicare supplemental plan. And it DOES NOT act as one, except for paying the bills. Medicare does not regulate or have any ‘say’ over how it is run. Whether you use it or not, Medicare does not recognize it as one of their plans. That was my whole point.

I was on a free employer plan past age 65. When it was no longer paid for by my past employer, I wanted to change to a Medicare-compliant plan but had to go thru medical underwriting and almost couldn’t find a plan that would accept me because of my medical history. Luckily, each company asks different underwriting questions and it is somewhat well-known who has easier questions (AARP United HealthCare). Once you are on one of the Medicare supplemental plans, it is easy to change to another one, if your state rules allow changes.
Your analogy is specious. You might as well say that Social Security benefits are just like a corporate pension.

TFL, like Medicare, was established by Congress. See https://www.law.cornell.edu/cfr/text/32/199.17. So it will literally take an act of Congress to make changes. That same Congress could make changes to Medicare.
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Re: My mother has Tricare for Life, but was persuaded to sign up for a Medicare Adv Plan... should I urge her to withdra

Post by Dusn »

Medicare is far superior to Medicare “advantage”
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