Medicaid + Tricare + Medicare

[sshafran]

I used to not offer any plan when someone had TFL since it works as great coverage.

Now, I'll talk to them about considering an MA PPO. I send them this and I explain it verbally:

Here is how the flow of claims works:

Medicare A&B + Tricare
- Medicare gets the claim as primary
- Medicare pays and sends the claim to WPS (tricare billing) for processing as secondary

Medicare Advantage + Tricare
- Medicare Advantage carrier gets the claim as primary
- Medicare Advantage carrier does not send the claim to WPS
- The provider would either need to send the claim to WPS as secondary or you may need to get involved with the filing so that Tricare can pay as secondary (Form DD2642 - found here)

 

[DonP]

I used to not offer any plan when someone had TFL since it works as great coverage.

Now, I'll talk to them about considering an MA PPO. I send them this and I explain it verbally:

Here is how the flow of claims works:

Medicare A&B + Tricare
- Medicare gets the claim as primary
- Medicare pays and sends the claim to WPS (tricare billing) for processing as secondary

Medicare Advantage + Tricare
- Medicare Advantage carrier gets the claim as primary
- Medicare Advantage carrier does not send the claim to WPS
- The provider would either need to send the claim to WPS as secondary or you may need to get involved with the filing so that Tricare can pay as secondary (Form DD2642 - found here)

I know the potential sounds daunting . I used to be scared to do Tricare and ma . But since I’ve written so many I consider myself seasoned in it . If I even had gotten 1call I’d have backed off . But got zero . Were also told not to write champus and ma as the billing quirky . I haven’t but I run into many and they say no issues and like it .

 

[kgmom219]

Bob...

1. Confirm the Medicaid status at Jarvis
2. Assuming she has Medicare, Medicaid and Tricare, she's good. She's not paying the Part B premium. And everything is going to be covered at $0, from either Medicaid or Tricare. I would just make sure she knows to show all 3 cards everywhere.

 

[somarco]

If they are fine paying the copays at time of service and filing for reimbursement, then MAPD may be an option, but if someone is on Medicaid, there is a stronger likelihood in my experience that there may be a knowledge gap for them in getting that done.

Every situation is different, and each of us handle prospects/clients differently.

I understand that almost everyone T65 is coming off a PPO (or HMO) plan. I also understand that most people who have had a PPO plan never had a major illness or accident and are not aware of how complicated managed care can be, especially with a hospital inpatient situation.

Not everyone 65+ is computer savvy, knows how to find par providers, figure out an EOB, know what to do when your claim is denied . . . other than just pay it.

I make life simple for them and give them access to manageable cost health care. Frankly, I don't know how most folks, of any age but especially 65+, understand how to use their plan, maximize benefits and minimize OOP.

And yes, there is a knowledge gap.

I have folks (a few) who opted for plan N . . . and now they regret it . . . unfortunately most can't escape it.

I make exactly $0 on situations like this and never regret it. The lady who called me now has a better understanding of her plan and (hopefully) will be able to recoup at least SOME of her OOP for copay's, etc where providers thought she only had TFL.

Most of my clients have no real grasp of how their drug plan works. I have no idea how they would ever figure out an MAPD plan.

 

[somarco]

Bob...

1. Confirm the Medicaid status at Jarvis
2. Assuming she has Medicare, Medicaid and Tricare, she's good. She's not paying the Part B premium. And everything is going to be covered at $0, from either Medicaid or Tricare. I would just make sure she knows to show all 3 cards everywhere.

I talked to her today, she has a better grasp of things but still not sure if she has Medicaid or not. I suspect she does have all 3 since Medicare told her she has Medicare and is sending out a replacement card and, two, she claims she has not been paying a premium for anything.

You and I both know that some folks really have no idea what they have or how it works.

I assume this is the Jarvis you speak of . . .
Sign In

Not appointed with UHC and never will be. I think Anthem has something similar, but I don't have any low income, subsidy clients. That's just not my market. I am probably leaving millions on the table but I really don't care. I have my corner of the universe and all is well in my world.

That's the nice thing about being self employed . . . you can set your own hours, define your market, make as much (or as little) as you want/need and SWAN.

later,
bob

 

[kgmom219]

I talked to her today, she has a better grasp of things but still not sure if she has Medicaid or not. I suspect she does have all 3 since Medicare told her she has Medicare and is sending out a replacement card and, two, she claims she has not been paying a premium for anything.

You and I both know that some folks really have no idea what they have or how it works.

I assume this is the Jarvis you speak of . . .
Sign In

Not appointed with UHC and never will be. I think Anthem has something similar, but I don't have any low income, subsidy clients. That's just not my market. I am probably leaving millions on the table but I really don't care. I have my corner of the universe and all is well in my world.

That's the nice thing about being self employed . . . you can set your own hours, define your market, make as much (or as little) as you want/need and SWAN.

later,
bob

Not my market, but when I get one, I really enjoy helping them. A couple are from ACA to T65 but I've got this one who is legally blind, husband died (widow maker heart attack) lived upscale and found out after his death they owed a ton, there were no assets left, SSA is almost nothing because she never worked and he reported almost no income. Total tale of whoa. She's moved in with her sister and I was able to figure it out and get her on a dual plan.

 

[DonP]

She probably is on partial Medicaid Qi1or slmb . Means govt paying her part b $170.10 but she still has full cost sharing responsibility on her mapd plan . So Tricare blows it away . If anything put her on partial dual plan as she’ll get a $75 monthly food card . But tell her t never use her ma card . She 100% has a pdp card for drugs if she’s on partial Medicaid. It’s far superior than tfl for drugs .

 

[somarco]

Not my market, but when I get one, I really enjoy helping them. A couple are from ACA to T65 but I've got this one who is legally blind, husband died (widow maker heart attack) lived upscale and found out after his death they owed a ton, there were no assets left, SSA is almost nothing because she never worked and he reported almost no income. Total tale of whoa. She's moved in with her sister and I was able to figure it out and get her on a dual plan.

I know a few folks with similar stories . . . not as destitute as this lady but shocked to discover the widow is pretty much broke. There are some real mixed feelings in that kind of thing. Some involved the husband's suicide . . .

I know what you mean about helping folks.

Always nice when we can make a buck or two, but I never turn anyone away where there is no comp. My grandfather was a mechanic (1920's). He was supposedly the best one in town (pop about 7,000) but they never had much money. My grandmother said he did too many "thank you" jobs.

Guess I inherited that trait but I manage to squeeze enough paying jobs to live comfortably.

 

[kgmom219]

I
Guess I inherited that trait but I manage to squeeze enough paying jobs to live comfortably.

And I am 100% convinced that our attitude towards the no comp people is why we are successful over the long term.

 

[somarco]

And I am 100% convinced that our attitude towards the no comp people is why we are successful over the long term.

You are probably right.

Kenny Rogers said "Don't count your money when you are sitting at the table" and I believe it. There were times when money was tight and I had to work real hard to hide my desperation. Other times when I took an app that paid less than $10 per month commission.

I never forgot those days, and have carried that forward. You never know when a no comp person will refer people who will become a paying client.