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Reply to Part D Penalty for Medicare Advantage     
Old 08-10-2017, 09:09 PM   #11
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
[quote=lifeismylife76;1197440]
Originally Posted by yogooglethis View Post
For supplements yes always but sometimes an MA is a good fit if they want the free gym membership etc. and all the providers are in network.Tricare will coordinate with MA





That's what I thought. They can have both. Her problem is that a specific medication she needs is in short supply and the alternative is very costly. So she has no subsidy and only Original Medicare and TriCare. I told her I can't do anything until October but the drug she needs can be ordered through a MAPD and she could get some of the other extra benefits. If she can't have an MAPD and TriCare, can I enroll her in a stand alone prescription drug policy to fix her problem without a penalty? I'm not desperate for the sale, I'm trying to fix a problem. Maybe I wasn't clear on that in my original post.
TriCare for Life DOES NOT COORDINATE WITH Medicare Advantage plans. In my 18 years in this business, a TriCare for Life individual is a definite walk-a-way. You have TriCare for Life and then TriCare the latter is a plan for those NOT ON MEDICARE. I've seen many individuals over my years who have similar problems, but the best advice is for them to remain on TriCare for Life. If you should be so bold as to put them on a MAPD or PDP, you will be doing them a huge disservice because you will effectively pull them out of TriCare and they will never be able to get it back. I've never come across a case that made sense to do that. If you intend to move them, I'd advise you to make sure your E&O up to date is all I can add. This is a example of some of the hardships that exist in our present medicare world. Many are between a rock and a hard place such as this individual. The better option for you would be to see if they are eligible for LIS, MSP or if there is a local Pharma-program. In addition, ALL drug companies have need based programs they offer. Go to the manufacturers website and look for their Patient Assistance Program. Those would be the best solutions, but most certainly not moving them to a MAPD or a PDP.
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Old 08-10-2017, 09:43 PM   #12
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
[quote=roygbiv;1197487]
Originally Posted by lifeismylife76 View Post

TriCare for Life DOES NOT COORDINATE WITH Medicare Advantage plans.
I don't believe that is a correct statement.

Medicare Advantage is other health insurance providing Medicare Part A and Part B coverage and the Medicare Advantage beneficiary pays a Part B premium. TriCare for Life would coordinate with the Medicare Advantage plan under TriCare's provisions for coordination with other health insurance.

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LD is a Life Ins. & Medicare Supplement Consumer learning about Medicare

"...no space of regret can make amends for one life's opportunity misused..."
A Christmas Carol

Last edited by LostDollar; 08-10-2017 at 10:08 PM.
  Reply With Quote to Part D Penalty for Medicare Advantage
Old 08-10-2017, 10:13 PM   #13
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
[quote=LostDollar;1197499]
Originally Posted by roygbiv View Post

I don't believe that is a correct statement.

Medicare Advantage is other health insurance providing Medicare Part A and Part B coverage and the Medicare Advantage beneficiary pays a Part B premium. TriCare for Life would coordinate with the Medicare Advantage plan under TriCare's provisions for coordination with other health insurance.

Don't believe? Well, try it and give us feedback. Would welcome first hand knowledge proving it works. Good luck.
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Old 08-10-2017, 10:54 PM   #14
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
[quote=roygbiv;1197487]
Originally Posted by lifeismylife76 View Post

TriCare for Life DOES NOT COORDINATE WITH Medicare Advantage plans. In my 18 years in this business, a TriCare for Life individual is a definite walk-a-way. You have TriCare for Life and then TriCare the latter is a plan for those NOT ON MEDICARE. I've seen many individuals over my years who have similar problems, but the best advice is for them to remain on TriCare for Life. If you should be so bold as to put them on a MAPD or PDP, you will be doing them a huge disservice because you will effectively pull them out of TriCare and they will never be able to get it back. I've never come across a case that made sense to do that. If you intend to move them, I'd advise you to make sure your E&O up to date is all I can add. This is a example of some of the hardships that exist in our present medicare world. Many are between a rock and a hard place such as this individual. The better option for you would be to see if they are eligible for LIS, MSP or if there is a local Pharma-program. In addition, ALL drug companies have need based programs they offer. Go to the manufacturers website and look for their Patient Assistance Program. Those would be the best solutions, but most certainly not moving them to a MAPD or a PDP.
Excellent advice IMHO. I don't believe Tricare would coordinate with an MAPD, as my understanding is that you can't have two drug plans. You can have a PDP or MAPD with VA however. This is my understanding of the guidelines.
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Old 08-11-2017, 12:05 AM   #15
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
The MAPD Plan pays as primary. Tricare will pay any copays. UHC, at least in some markets, has the Essential plan, which is designed for those on Tricare for Life. It carves out the Part D plan, because generally, Tricare For Life RX benefits are better as it doers not have the Donut hole issue as does a Part D plan. Enrollees don't give up Tricare, they add the MAPD plan. Those who enroll, do it for the extras...Gym membership, hearing aid, etc. and not for the Rx benefits.
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Old 08-11-2017, 07:48 AM   #16
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
Originally Posted by grod View Post
The MAPD Plan pays as primary. Tricare will pay any copays. UHC, at least in some markets, has the Essential plan, which is designed for those on Tricare for Life. It carves out the Part D plan, because generally, Tricare For Life RX benefits are better as it doers not have the Donut hole issue as does a Part D plan. Enrollees don't give up Tricare, they add the MAPD plan. Those who enroll, do it for the extras...Gym membership, hearing aid, etc. and not for the Rx benefits.
This now takes us full circle back to OP's specific problem.

Originally Posted by lifeismylife76 View Post
That's what I thought. They can have both. Her problem is that a specific medication she needs is in short supply and the alternative is very costly. So she has no subsidy and only Original Medicare and TriCare. I told her I can't do anything until October but the drug she needs can be ordered through a MAPD and she could get some of the other extra benefits. If she can't have an MAPD and TriCare, can I enroll her in a stand alone prescription drug policy to fix her problem without a penalty? I'm not desperate for the sale, I'm trying to fix a problem. Maybe I wasn't clear on that in my original post.
OP's client needs a drug which apparently can't currently be obtained through a military pharmacy but apparently can be obtained through a civilian pharmacy with an MA-PD plan.

This turned up in some reading I did:

ADDITIONAL INFORMATION
Although you can have both TRICARE and a Medicare drug plan, the Medicare drug plan will always pay first for Medicare-covered drugs. TRICARE will then pay for TRICARE-covered drugs. Please contact the TRICARE Pharmacy Program at 1-877-363-6337 for more information.
It looks like adding a Medicare drug plan to obtain the scarce drug may have unanticipated cost consequences for all other Medicare provided drugs the client takes.

Maybe a call to that number will provide specific problem directed answers.

------------------------------------
LD is a Life Ins. & Medicare Supplement Consumer learning about Medicare

"...no space of regret can make amends for one life's opportunity misused..."
A Christmas Carol

Last edited by LostDollar; 08-11-2017 at 07:54 AM.
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Old 08-11-2017, 12:34 PM   #18
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
Originally Posted by lifeismylife76 View Post
Her problem is that a specific medication she needs is in short supply and the alternative is very costly. So she has no subsidy and only Original Medicare and TriCare.
Has she applied to have the non-formulary drug covered as an exception?

You can get the non-formulary drugs at the formulary cost share if your provider can establish medical necessity.

Additional information: https://tricare.mil/CoveredServices/...s/NonFormulary

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Old 08-11-2017, 06:43 PM   #19
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage
Originally Posted by grod View Post
The MAPD Plan pays as primary. Tricare will pay any copays. UHC, at least in some markets, has the Essential plan, which is designed for those on Tricare for Life. It carves out the Part D plan, because generally, Tricare For Life RX benefits are better as it doers not have the Donut hole issue as does a Part D plan. Enrollees don't give up Tricare, they add the MAPD plan. Those who enroll, do it for the extras...Gym membership, hearing aid, etc. and not for the Rx benefits.


Ding Ding Ding We have a winner! They are few a far between but it can work well for some.Looks like some agents may have walked away from good cases.
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Old 08-16-2017, 04:16 PM   #20
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Part D Penalty for Medicare Advantage Re: Part D Penalty for Medicare Advantage lifeismylife76 is the thread starter for: Part D Penalty for Medicare Advantage

[quote=roygbiv;1197487]
Originally Posted by lifeismylife76 View Post

TriCare for Life DOES NOT COORDINATE WITH Medicare Advantage plans. In my 18 years in this business, a TriCare for Life individual is a definite walk-a-way. You have TriCare for Life and then TriCare the latter is a plan for those NOT ON MEDICARE. I've seen many individuals over my years who have similar problems, but the best advice is for them to remain on TriCare for Life. If you should be so bold as to put them on a MAPD or PDP, you will be doing them a huge disservice because you will effectively pull them out of TriCare and they will never be able to get it back. I've never come across a case that made sense to do that. If you intend to move them, I'd advise you to make sure your E&O up to date is all I can add. This is a example of some of the hardships that exist in our present medicare world. Many are between a rock and a hard place such as this individual. The better option for you would be to see if they are eligible for LIS, MSP or if there is a local Pharma-program. In addition, ALL drug companies have need based programs they offer. Go to the manufacturers website and look for their Patient Assistance Program. Those would be the best solutions, but most certainly not moving them to a MAPD or a PDP.


I called TriCare for Life directly today and was advised they CAN have a Medicare Advantage Plan also. It can benefit them with some of the extra benefits in the plans in my area. Thank you for the information about the prescription drug assistance!
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