Any Veterans use a Medicare Part C with Tricare for Life?

[Tekward]

Hi all. Retired Navy currently using Medicare A&B with TFL as a secondary.

I had been looking forward to Silver Sneakers but that is not available without Part C. Has anyone explored a program as described below? It seems too good to be true and I'm reluctant to trust a salesperson on such a complex product. Thanks in advance.

The Humana Honor plan is available in 46 states, is a PPO (not HMO) allowing you to use any doctor who accepts Medicare nationwide and do not require a referral to see a specialist. There is a big difference between a Part C HMO from a small insurance company, which limits your options substantially and a PPO from Humana or UHC. These plans vary slightly from state to state but include these benefits.
– zero premium (Must continue to pay Part B premium)
– vision, hearing and dental coverage ($2000 a year dental max per year typically)
– Medicare Part B premium credit- $75-$125 a month, varies from state to state
– SilverSneakers Gym membership
The standard Medicare Part B premium for 2023 is $164.90 a month. So as an example, if you enroll in a Part C plan with a $100 month Part B credit, your Medicare Part B premium with be $64.90 each month.
This causes your social security check to increase $100 a month or $300 less you pay quarterly if you are not receiving social security benefits. The Part B credit is per person, per month and happens automatically.
Most of you are reading this because you just want to get SilverSneakers. The Humana Honor plan accomplishes that AND saves you $1200+ a year per person on your Medicare Part B premium, includes hearing, vision and dental coverage.

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[teej1985]

Have to think you're better off just buying a gym membership. Don't most gyms have senior discounts? Part B and Tricare is gold plated....why switch to a (Dis)Advantage plan?

 

[RetiredAndLovingIt]

Go to silversneakers.com and browse their gyms in your area and then check the price to sign up on your own. You probably have better insurance with TriCare and if you leave it can you get back in later?

 

[friar1610]

USN (Ret) here also. I’ve done a little web research on the Part C plans (although I probably haven’t looked at the one the OP specifically mentions). I’m big on working out and Silver Sneakers would be a big draw for me. But I keep coming back to the fact that I’m VERY happy with Medicare A and B plus TFL (as well as with my current providers) and I don’t want to upset the Apple cart at this stage of my life.

 

[Tekward]

I found that USAA offers Humana Honors but does not advise it for those on TFL.


"Probably not. Medicare Advantage Plans are a better fit for veterans who need to expand their health care options beyond their current VA health benefits."

https://www.usaa.com/inet/wc/insurance-humana-advantage

 

[badatmath]

IDK how it would be an improvement. MA tend to require prior auth frequently which may delay or deny treatment. https://www.kff.org/medicare/issue-...ubmitted-to-medicare-advantage-plans-in-2021/

 

[Tekward]

Thanks to all for the input. My high level read right now:

COST - the Humana Honor Advantage program would save me ~$2K annually (monthly $99 & tax for gym membership & $64 reimbursement for Medicare Part B).

COVERAGE - The disadvantage seems to be prior authorizations (3% denial rate per the article of badatmath), and differing situational coverage.

EXTRAS - The MA plan has no medical deductible, has a maximum out of pocket cap, a $300 OTC allowance, and includes some dental & vision coverage.

 

[Tekward]

Interesting article from a previous thread:

"Medicare Advantage companies often tout “zero premium” plans, and some offer out-of-pocket expenses lower than traditional Medicare and are often zero. What’s more, some plans cap out-of-pocket expenses at a total of $9,500 for combined in- and out-of-network coverage (the details depend on the plan). In addition, Medicare Advantage companies are paid a fixed amount of money each month by the government. So the companies have a strong incentive to reduce their costs by providing more generous coverage for medicines that keep you out of the hospital."

https://www.msn.com/en-us/money/per...make-when-picking-a-medicare-plan/ar-AA1fiYHY

 

[badatmath]

Interesting article from a previous thread:

"Medicare Advantage companies often tout “zero premium” plans, and some offer out-of-pocket expenses lower than traditional Medicare and are often zero. What’s more, some plans cap out-of-pocket expenses at a total of $9,500 for combined in- and out-of-network coverage (the details depend on the plan). In addition, Medicare Advantage companies are paid a fixed amount of money each month by the government. So the companies have a strong incentive to reduce their costs by providing more generous coverage for medicines that keep you out of the hospital."

https://www.msn.com/en-us/money/per...make-when-picking-a-medicare-plan/ar-AA1fiYHY

From your very own article "Meanwhile, those cost savings on out-of-pocket expenses only apply if you stay in network."

Really up to you I guess. Me, not a gambler. I want flexibility.

 

[zl55lz]

Thanks to all for the input. My high level read right now:

COST - the Humana Honor Advantage program would save me ~$2K annually (monthly $99 & tax for gym membership & $64 reimbursement for Medicare Part B).

COVERAGE - The disadvantage seems to be prior authorizations (3% denial rate per the article of badatmath), and differing situational coverage.

EXTRAS - The MA plan has no medical deductible, has a maximum out of pocket cap, a $300 OTC allowance, and includes some dental & vision coverage.

You might also want to compare the prescription coverage of any Advantage plan versus TFL, or if maybe TFL would pick up any balance after the Advantage Part D plan pays? Also, I would check with TFL to see how the Coordination of Benefits works with an Advantage Plan as compared to regular Medicare.

 

[Tekward]

A fairly negative take on how MA saves costs by using algorithms to deny coverage.
https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/

 

[REWahoo]

"Advantage companies are paid a fixed amount of money each month by the government. So the companies have a strong incentive to reduce their costs by providing more generous coverage for medicines that keep you out of the hospital."

Advantage companies also have a strong incentive to reduce their costs by denying treatments, discharging earlier than might be reasonable (see above), and finding other ways to prioritize cost containment rather than patient care. Not that any insurance company would ever do something like that of course...

 

[Tekward]

Another article that gives me pause.

Medicare Advantage plans seem enticing, but here are 12 things to consider before signing up

https://finance.yahoo.com/news/medicare-advantage-plans-seem-enticing-125205784.html

 

[zl55lz]

A fairly negative take on how MA saves costs by using algorithms to deny coverage.
https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/

Thanks for posting the links to articles. Although we are on FEHB (Federal) + Medicare A/B, I had been taking a look at the newer FEHB Advantage options, as well as publicly offered MA plans.

I keep reading about the MA plan issue of approving care--and this is now twice I have seen something about the companies using/owning the algorithm companies--I am staying with Original Medicare+FEHB. It has been very dependable.

With our situation I can't be wondering if/when treatment will be approved.

 

[Tekward]

I agree z. That's where I've landed. The harder the insurance companies market something the more suspicious I become.

 

[badatmath]

I agree z. That's where I've landed. The harder the insurance companies market something the more suspicious I become.

This internet stranger thinks you are making the right choice to avoid. . . Health is really the most important asset you have, period.

 

[zl55lz]

I agree z. That's where I've landed. The harder the insurance companies market something the more suspicious I become.

From what I saw taking a look at Tricare for Life with Medicare, I don't know if it gets any better than that. The coverage looks very solid, including Rx benefits--it appears you have zero premium in addition to Medicare, and the Rx copays look great to me. I am in FEHB and it has great coverage but we do have to pay a premium in addition to Medicare B--a quick look at premiums shows they can be from approx $250-$700 per month for a self plus spouse--in addition to the Part B premium!!! Seems very high to me for being secondary, covering the 20% Medicare B doesn't pay and what I consider to be fair to moderately good Rx coverage. Just my opinion.

So enjoy your benefits! You earned them, and thanks for your service!

 

[braumeister]

From what I saw taking a look at Tricare for Life with Medicare, I don't know if it gets any better than that.

As a long time user of that combination I agree.

 

[stedmakr]

Tekward - many consider tricare for life with it's embedded premium free drug plan the gold standard Medicare setup. Tricare for life serves as wraparound coverage for Medicare. It works like a premium free medigap plan. There are no prior approvals for a medicare cost/procedure.

Don't minimize the significance of prior approvals that are a key caveat with all advantage plans.. When you are sick or injured you don't want to be worried about whether your insurer is going to pay for your Healthcare.

Do not compromise your heathcare for a gym membership or some other bauble that an advantage plan offers.

You have without argument the best medicare options available. Insurance brokers/agent make commissions from advantage and medigap plans. They can't make a commission from TFL.

 

[grayv]

one nice thing ...... you can drop an advantage plan and return to medicare B plus TFL without underwriting or asking permission. I suppose "open season" rules would apply.

 

[Tekward]

One anecdote:
As a nurse working in an office, I highly recommend Traditional Medicare with Plan G. Can’t tell you how many tests and procedures get delayed or denied by “Advantage” plans. We call them disadvantage plans. If you have any preexisting conditions especially just go with Medicare primary and a supplement. Higher premiums but no hassle and little to no money out of pocket.

Medicare has a mission to provide you with healthcare. Insurance companies have an obligation to make a profit for the executives and their shareholders. This is the difference. Medicare Advantage plans, as someone stated previously, is a ‘replacement’ for Medicare by an insurance company. They take the Medicare dollars that you paid into the system for a lifetime and make a profit by rationing out your healthcare to you.

 

[braumeister]

one nice thing ...... you can drop an advantage plan and return to medicare B plus TFL without underwriting or asking permission. I suppose "open season" rules would apply.

Worth noting that you don't lose TFL even if you sign up for an advantage plan. TFL will still be the second payer for Tricare-covered services.

However, it's not automatic since claims will not go through Medicare where they are seamlessly sent on to TFL. You will have to file claims yourself for reimbursement of any costs the advantage plan doesn't pay.