Medicare, Tricare, and Medicare Advantage.... Why MA

By Joe Leech, USAF Retired

As a military retiree, you've navigated the complexities of healthcare, from military benefits to Medicare. But have you considered adding Medicare Advantage to your healthcare portfolio? In this article, we'll explore why you should consider this option and how it can enhance your healthcare coverage.

Understanding the Basics

Before diving into the benefits of Medicare Advantage, let's review the essentials. To even consider Medicare Advantage, you must have Medicare Parts A and B. Part A covers hospitalization, typically automatic at age 65, while Part B handles doctor visits and other medical expenses, with a monthly premium.

Medicare's coverage, however, has its gaps. After meeting your deductible, you're responsible for 20% of the remaining medical bills, and there's no cap on this cost. Prescription drugs aren't covered under basic Medicare, and late enrollment penalties can apply if you delay Part B without equivalent coverage.

The Birth of Medicare Advantage

Now, let's explore Medicare Advantage, often referred to as Medicare Part C. Medicare Advantage plans emerged to address the shortcomings of traditional Medicare. They come in various forms, such as HMOs, PPOs, and PFFS, and are offered by private insurers.

Initially, these plans focused solely on medical expenses. However, they've evolved over time to offer more comprehensive coverage. One significant addition was prescription drug coverage through Part D plans. Later, they introduced "ancillary" benefits, such as dental, vision, hearing, health club memberships, and over-the-counter benefits.

The Appeal of Medicare Advantage

One of the primary appeals of Medicare Advantage is its convenience. Instead of managing separate Part D and Medigap plans, you can have a single Medicare Advantage plan that covers medical, prescription, and ancillary benefits.

Moreover, most Medicare Advantage plans come with a $0 monthly premium, making them cost-effective options. The specific benefits, costs, and availability of plans can vary by region, so it's essential to compare plans in your area.

Tricare Considerations

If you're a military retiree with Tricare, you might wonder whether you need Medicare Advantage. Tricare can be thought of as a supercharged Medicare supplement, covering medical and prescription costs. In most cases, Tricare's robust coverage may eliminate the need for additional Medicare Advantage coverage—at least for MEDICAL benefits.

What You Might Be Missing

However, it's crucial to consider Medicare Advantage plans offer benefits that Tricare does not. These plans provide several extra benefits that can enhance your overall healthcare experience. These may include dental plans, active health club memberships, 24-hour telehealth services, over-the-counter shopping cards, hearing and vision assistance, transportation allowances, and Part B "givebacks." The latter can range from $30 per month to over $100. OTC benefits typically are in the range of $100 per quarter, and some plans include an additional allowance of $100 for “healthy food”. As we have mentioned dental plans, you can expect a first pay benefit in the area of $3000.

Enrollment Process

If you decide to explore Medicare Advantage, ensure you have active Part A and Part B coverage. You can enroll during the Annual Enrollment Period, typically from October 15 to December 7. Remember that agents and brokers are prohibited from soliciting you, so you must initiate contact to gather information or set up an appointment.

In conclusion, while military retirees with Tricare may not have a pressing need for Medicare Advantage, it's worth considering for the additional benefits it offers. The convenience, cost-effectiveness, and comprehensive coverage of these plans can greatly benefit your overall healthcare experience. Take the time to research and compare plans available in your area during the Annual Enrollment Period to make an informed decision about your healthcare coverage.

For those desiring additional information on Tricare, the official handbook can be seen at https://tricare.mil/Publications/Handbooks/tricare_for_life where a hard copy can be ordered or a free copy downloaded as a .pdf

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About the Author: Joe Leech is a retired USAF veteran, having served 32 years combined active and reserve service with both the USAF and USNavy. He was commissions in 1960 as a Distinguished Military Graduate in his AFROTC class at Allegheny College. Upon leaving active duty in 1971, he entered into civilian employment, eventually owning his own Manufacturers’ Rep business. During that time he also earned his first life and health insurance license. He chose to specialize in Medicare in 2005 and has been practicing ever since. He currently holds active icenses in PA and FL and in the last five years has focused on working with military retiree over age 65. He lives in Pittsburgh with his wife of 62 years, Ruth Ann where he enjoys reading and playing piano. He and his wife are also active members of Bethlehem Lutheran Church.