Tricare for Life and Medicare, what does one gain or lose if one signs up for Medicare part C?

2024-12-08T20:48:37-05:00

I've been informed that accepting Medicare part D will affect one's Tricare Prescriptions, but what about Part C??? With what is offered by various Medicare supplement providers is the part C supplement worth purchasing?

Response by COL Randall C. made Dec 8 at 2024 11:19 PM

2024-12-08T23:19:18-05:00

When using Medicare or Medicare Advantage (M/MA) with TRICARE For Life (TFL), M/MA pays first and TFL pays second. There are three situations you could encounter – both cover the procedure, M/MA covers but TRICARE doesn’t (MYTN), or M/MA doesn’t but TRICARE does (NMTY).
• Both – M/MA pays and TFL picks up the rest (see note below).
• MYTN – Medicare pays 80%, TFL pays 0%, and you pay according to your plan (remaining deductible, copay, etc.)
• MNTY – Medicare pays 0%, TRICARE covers the cost, and you have a TFL co-pay (typically 20%* for most TRICARE in-network doctors) and any remaining TFL deductible ($3,000 for 2024).

Note: If you’re seeing a Medicare authorized doctor that doesn’t accept the Medicare assignment amount, the doctor can charge up to the ‘limiting charge’ for the procedure (set by Medicare, but the max will not exceed 15% over the Medicare-allowed amount). If you have TFL, they will cover that 15%.

The biggest impacts with a Medicare Advantage plan you will have are:

• Additional costs or benefits with a Medicare Advantage plan

This is the key factor you'll be weighing to see if the Part C plan is worth purchasing. Some Medicare Advantage plans will reimburse a portion/all of your Part B premiums. Some will expand coverage and include dental and eye care as well (TFL doesn’t cover either unless medically necessary). Some will give non-medical benefits such as transportation allowances, fitness memberships, etc.

On the other side of the comparison is if there is any additional costs involved. Some plans will offer some significant benefits, but will charge you a Part C premium that is in addition to the Part B premium you will still pay.

• Many Medicare Advantage plans restrict the doctors you can see.

All the doctors in the plan must be "Medicare participating", but not all Medicare participating doctors are in the plan's network (i.e., "all squares are rectangles, but not all rectangles are squares"). That means your choice using a Medicare Advantage plan will usually be limited compared to Medicare (not always, but it's very common).

• TFL works seamlessly with Medicare - not so much with Medicare Advantage (but...)

With Medicare, TFL is seamlessly integrated into the reimbursement. The doctor bills Medicare, Medicare pays their 80%, the remaining portion of the bill is sent to TFL, and TFL pays the physicians directly. No involvement needed by you.

With a Medicare Advantage plan, TFL acts as a secondary insurance, which means there isn't a seamless coordination between the two - Medicare won't send the remaining bill to TRICARE so you may have to submit the bill to TFL to be reimbursed. However, many doctor's offices will handle two insurances for their patients. They will bill your Medicare Advantage plan and submit the remainder to TFL when it comes back. If your doctor's office does that, then it will still be seamless for you. If they don't then it falls back on you to submit for reimbursement.
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* https://www.cms.gov/medicare/physician-fee-schedule/search/overview
* TFL cost share (2024 as 2025 hasn’t been posted yet) - https://tricare.mil/Costs/HealthPlanCosts/TFL/Retiree_Rates

PFS Look-Up Tool Overview | CMS

PFS Look-up Tool OverviewWhat's the PFS Look-Up Tool?The PFS Look-Up Tool gives Medicare payment information on more than 10,000 services, including:PricingAssociated relative value units (RVUs)Payment policiesThe tool doesn’t display Medicare Administrative Contractor (MAC) priced codes or Medicare Part B non-payable codes.

Response by MSgt Michael Bischoff made Dec 10 at 2024 10:31 PM

2024-12-10T22:31:25-05:00

If you can get a part C lower than the eye and dental, cheaper than FEDVIP might be worth a look.

Response by SGT Lorenzo Nieto made Dec 11 at 2024 7:12 AM

2024-12-11T07:12:47-05:00

Money out of your pocket I have part B,C, $185 a month sad thing I never use it I’m 100% how ever VA does not cover you for dum stuff we do nor do they cover you for auto accidents.