Tricare & Medicare Guide

These are the sections of this guide that appear in order on this page.

Medicare & Tricare – Important Facts To Know
The Parts Of Medicare
Medicare Advantage
Standard Medicare Vs. Medicare Advantage
Featured Heroes Tesmionials
Request Info On Available Plans & Benefits
Frequently Asked Questions
Downloads

After reading, Click Here to download/print this guide.

Starting Medicare With Tricare

Upon eligibility for Medicare Parts A & B, they ascend to your primary medical coverage, overseeing doctor visits, treatments, and hospital stays. Enrollment in Medicare is open three months before your 65th birthday. Those already receiving Social Security benefits will be automatically enrolled in Medicare.

Transitioning to Tricare For Life, it seamlessly assumes the role of secondary insurance to Medicare, covering medical expenses not paid by Medicare and ensuring comprehensive coverage for Medicare A & B services.

Even after transitioning to Medicare, Tricare continues to safeguard your prescription coverage.

Medicare presents two primary coverage options: the government-provided Original Medicare or the privately managed Medicare Advantage plans. Regardless of your choice, Tricare functions effectively as secondary insurance, covering copayments associated with both Original Medicare and Medicare Advantage plans.

This enhanced coverage strategy ensures that as a retired service member or spouse, you have robust healthcare coverage, merging the benefits of Medicare with the support of Tricare for a seamless healthcare experience.

Facts To Know

When you become eligible for Medicare A & B, it will become your primary medical coverage for doctors care, treatment, and hospitalization. You can apply to enroll in Medicare 3 months before the month you turn 65. If you are already receiving Social Security you don’t need to apply, you’ll be automatically enrolled.
Tricare automatically converts to Tricare For Life and becomes your secondary insurance to Medicare. Tricare For Life will cover all medical costs not paid by Medicare, essentially giving you 100% coverage (For Medicare A & B services).
Tricare continues to provide you with prescription coverage after you start Medicare.
With Medicare, you have two main choices as to how you are covered. You can choose to get Medicare directly through the government (Original Medicare) or through private health plans known as Medicare Advantage.
Tricare can be billed as your secondary insurer for copays with either Original Medicare or private Medicare Advantage.

Need To Know

To maintain your Tricare benefits, you must enroll in Medicare when you become eligible.

The Parts Of Medicare

Medicare is structured into five distinct parts, with Parts A and B forming the core of your coverage. Part A primarily addresses inpatient hospital stays, care in skilled nursing facilities, and home health care services, ensuring comprehensive support during significant health events. Medicare Part B expands this coverage to include doctor visits and outpatient care, encompassing a wide range of medical services from routine check-ups to specialized treatments.

To form a solid foundation of health coverage, enrolling in Parts A and B is essential. Beyond this foundation, you have the flexibility to tailor your Medicare experience according to your specific health needs and preferences by considering the additional three parts. These include Medicare Part C (Medicare Advantage), which offers an alternative way to receive your Medicare benefits through private health plans, Part D for prescription drug coverage, and Medicare Supplement Insurance (Medigap) that helps cover costs not fully paid by Parts A and B.

This structure allows you to customize your healthcare coverage to fit your unique situation, ensuring you have the necessary protection and peace of mind to enjoy your retirement years.

The Other 3 Parts

Part C – More commonly known as Medicare Advantage, these are private insurance plans. You have the choice of being covered directly through Medicare or a Private Insurer.
Part D – Medicare prescription pharmacy benefits. Medicare does not provide coverage directly but instead through private insurers.
Supplements – Medicare Supplements are insurance plans that supplement Medicare A & B. They are offered by private insurers and help cover medical costs.

In most cases Part D is not needed because Tricare continues to provide good prescription benefits. Also, because Tricare For Life supplements Medicare, you don’t need a Medicare Supplement. Your main choice comes down to getting your coverage through Original Medicare or a Medicare Advantage plan (Part C).

Medicare Advantage

How Tricare Recipients Get The Most Medicare Benefits And Lowest Monthly Cost

With Medicare you have the choice of getting your benefits directly through the government (Original Medicare) or through a private plan known as Medicare Advantage.

Original Medicare and Medicare Advantage both encompass Medicare Part A, which covers hospital stays and Part B, addressing doctor visits and outpatient care. Regardless of your choice between these two options, Tricare seamlessly integrates as secondary insurance, providing additional coverage and peace of mind.

Original Medicare offers a uniform, comprehensive coverage model that is consistent across the United States, designed to meet the basic health care needs of all enrollees. It’s often seen as a “one size fits all” solution, ensuring everyone has access to essential health services.

On the other hand, Medicare Advantage presents a customizable approach to your health care coverage. The “Advantage” in Medicare Advantage lies in its ability to offer a broader range of benefits, potentially at the same or a lower monthly cost compared to Original Medicare. This plan is particularly suited for those seeking coverage that is tailored to their specific health needs and lifestyle preferences. The additional benefits available with Medicare Advantage plans can include:

Dental, Vision, and Hearing Aid coverage.
Silver Sneakers – Gives you free access to exercise facilities and online exercise videos.
Part B Giveback $ – This is a benefit included with some plans that gives you a dollar amount that reduces your monthly Medicare cost.
Prescription – There are Medicare Advantage options that include pharmacy coverage and some that do not.

Tricare continues to provide you with good prescription coverage, so in most cases, you don’t need this benefit with your Advantage plan. This allows you to choose a Medicare Advantage plan without prescription coverage, which has it’s own unique benefits.

Tricare As Secondary

Tricare can be your secondary insurance to Medicare Advantage and cover your medical copays. Medicare Advantage plans are available based on your state and county. There are specific plans designed for Veterans & their Families but they are not common and often hidden.

Request Info

For details on specific programs available to you.

Medicare Advantage Vs. Original Medicare Comparison

To get a better idea of how Medicare Advantage and Original Medicare compare, here is a comparison chart of the different features.

Feature	Original Medicare	Medicare Advantage
Total Monthly Cost	$164.90 In 2023	$40 – $164.90 In 2023
Includes A&B Hospital & Doctor Coverage	Yes	Yes
Doctor Networks	No Networks	Yes: PPO & HMO Options
Rx Included	No	Options With & Without
Dental & Vision	No	Yes
Hearing Aids	No	Yes: Often Included
Fitness / Health Club	No	Yes
Over The Counter Medicine, Vitamins, Other	No	Yes

This table provides estimates and a general comparison of Original Medicare & Medicare Advantage. Benefits & costs vary with different plans. Refer to plan specific documents such as the Summary of Benefits. Contact Us for details.

Part B Giveback $

Part B Giveback is a rebate that Retired Military, Veterans, and their Families can take advantage of to lower their monthly cost of Medicare.

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For more details on rebates available to you.

Featured Heroes Testimonials & Profiles

About our customers and what they have to say

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Brian served as a U.S. Marine from July 7th, 1975 through February 1st, 1996. Brian is currently working at Taylor Diesel of Lubbock in the sales and customer service department. He also has two part time businesses. The first, for ACN, a worldwide essential services company, providing services such as wireless, high speed internet, television, gas, and electricity. He also is an Independent Business Owner for Market America, an online shopping mall. Brian’s websites are; http://brianrayburn.acnibo.com / www.shop.com/brayburn .

Brian’s memories of his service are vast. In his words; “The camaraderie is what I miss the most. I would say my proudest moment was when I was selected for Warrant Officer. The transition from enlisted ranks to Officer wasn’t easy. Everyone suddenly became afraid of fraternization. One thing is certain, I never forgot where I came from.

Brian’s testimonial about working with us; “Working with them was painless and effortless. Ben Rodriguez went over various plans that best met my needs. He produced numerous training presentations, that explained the Medicare process in detail. The plan I chose offered a discount that is always welcomed. The professionalism of Ben Rodriguez and his staff was exceptional.”

*Lone Star Medicare, LLC. does not endorse and is not liable for products & services purchased from 3rd party consumer sites listed in this profile.

Brian RayburnUnited States Marine Corps, Captain O-3E, Retired

Michael Pauley served in the US Army from 1978 through 1998. He then served in the South Carolina National Guard from 1998 until 2001. After that, he served 20 more years in the US Army Reserve and US Navy. Michael’s most profound memory of his service is flying Dustoff / MEDEVAC. He currently lives in South Carolina and is a retired Lawyer, Soldier, Sailor, and Science Fiction Writer.

In his own words, Michael chose a Medicare Advantage plan with us because; “Having a Medicare Plan that is bundled through same provider and My Tricare, along with the outstanding service, make this a great fit for me.”

Michael PauleyUS Army, Retired

Patricia Hill served in the US Army for 21 years and 6 months. Her fondest memory of her service was completing her Rites of Passage. She says was a grueling week but helped her grow and build comradery. She currently lives in Virginia and enjoys gardening, reading, and home decorating.

In her own words; “It was a pleasure working with Lonestar Medicare and Medicare For Heroes. Ben provided quite a bit of information about Medicare/Medicare Advantage Programs. Especially important to me were plans geared towards Military Retirees and Veterans. Ben was also very responsive in answering my questions. Because of all of the information I received, I am confident that I chose the best Medicare Advantage plan to suit my healthcare needs.”

Patricia HillSgt. First Class, US Army, Retired

After 25 years of service in the US Air Force, Robert Wood retired as a Lt. Colonel in 2006. After that he worked for a defense contractor and retired from there in 2017. Robert currently lives in Texas where he enjoys supporting his wife who is a local teacher. He also has plenty of time to keep up the house and yard, which he didn’t before. His fondest memory of his service was last assignment with the 100th Air Refueling Wing, RAF Mildenhall, UK. “I enjoyed the people I worked with and worked for. We had great comradery and sense of teamwork to get the air-refueling mission accomplished.”

In his own words; “Starting Medicare, there seemed to be an overwhelming number of options available. I found an advertisement for Lone Star Medicare / Medicare For Heroes and gave them a call. I talked to Ben Rodriguez and he was very knowledgeable and interested in finding the best Medicare coverage for my personal needs. After he asked me several questions about my personal situation, he recommended the Humana Honor (PPO) Medicare Advantage Plan as the best fit for me. I chose this plan because it covers all of my healthcare needs, most of which were in Network for my current doctors. The Humana Honor plan works with Tricare for Life, which pays any additional costs and co-pays that the Humana Honor plan does not cover. I’m very happy with the Humana Honor (PPO) Medicare Advantage Plan and the outstanding service and assistance I received from Ben Rodriguez and Lone Star Medicare.”

Robert WoodLt. Colonel, US Air Force, Retired

Michael & Mona Harness both served in the US Air Force. Michael served for 21 years and Mona 14. They met in Yakota Air Force Base in Japan. Michael’s favorite memory is the wonderful airmen he had the pleasure of serving with. They currently live in Texas. Michael enjoys woodworking and fishing. Mona is enjoying quilting and yard work.

In their own words; Having used military medical all my adult life, I had zero knowledge of civilian medical care and the Medicare program. Medicare For Heroes was able to explain everything to me. I chose the Humana plan they recommended for me and have had nothing but good experiences. From dr visits to the otc program, I highly recommend Humana health care.”

Michael & Mona HarnessMaster Sgt., US Air Force, Retired

Harry served in the US Coast Guard for 24 years and 8 months. He was stationed at the Great Lakes, Florida, Louisiana, and finally in Port Arthur, Texas, which is where he met his wife Mada. Regarding his service he says; “One of my proudest accomplishments in the military was performing drug interdiction within the passes of Florida, Cuba and Mexico.”

Harry & Mada currently operate a marine surveying business, which Harry says is supported by the leadership skills he gained in the US Coast Guard. They have 6 children, 9 grandchildren, and enjoy traveling in their RV & boat.

In their own words they chose a Medicare Advantage plan through us because; “It has been a pleasure working with Ben Rodriguez with Lone Star and Medicare For Heroes. Entering into the Medicare system can be overwhelming and he was there to help guide us through the multitude of questions we needed answers to. The Humana Honor Health Plan has helped us save over $100 on our premiums. In fact, our co-pays are less than they were with our military insurance.

It is a PPO program, but we found all our primary care physicians and specialists are In-Network Providers. Being retired military, we have Tri-Care as our secondary plan. We haven’t had to change a thing. We are also taking advantage of the OTC pharmacy program for routinely purchased OTC drugs, such as 81 mg aspirin, vitamins and diabetic needs. Plus we have the added advantage of the hearing, dental and vision benefits that Medicare doesn’t include. This plan is adequately able to help even if you’re not real computer savvy. It is just as easy to handle any insurance business over the phone and the personnel are pleasant and willing to make sure all our needs are met.”

Harry & Mada StarkChief Petty Officer, US Coast Guard, Retired

Neil Houser served in the US Air Force for 20 years. His best memory is Working Heritage Park at England AFB in Alexandria, LA. He was was the Project Manager, in charge of Assembling all the Real Flying Tiger Aircraft and making them ready to Mount on Pedestals. Neil currently lives with his wife Irene in Texas where he works as an IT / Data Analyst. He enjoys golfing and music, which makes sense that he lives near Austin.

Neil and his wife have Tricare For Life and they chose a Medicare Advantage plan with us. In their own words, this is because; “I’ve been working with Ben Rodriguez and Medicare For Heroes for over a year now. We’ve been bombarded with Mail, Email, Social Media about Medicare and supplements. Ben has gone the extra mile to provide Education, and Support. He extremely knowledgeable and friendly. He is certainly 5 stars!”

Neil & Irene HouserMaster Sgt., US Air Force, Retired

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Call Us For Questions & More Info

Please feel free to call us at toll free 855.625.7633. We are available Monday through Friday from 9 am to 5:30 pm CST.

General Frequently Asked Questions

When will I start Medicare? If you are turning 65, you start Medicare the first day of the month of your birthday. If you are disabled, you typically start Medicare 24 months after you start receiving disability.

What Costs Are Associated With Medicare? Medicare has 2 types of costs; Monthly premiums and medical cost sharing. A premium is the cost you pay to have the coverage, typically monthly or quarterly. Cost sharing is what you pay when you have medical care. If you have secondary insurance such as Tricare, it can cover your medical cost sharing. These are items such as deductibles and copay’s. The standard monthly premium most people pay in 2023 is $164.90. There are ways to lower your monthly premium such as Part B giveback and state programs, Contact Us for details.

When should I apply for Medicare? First, if you are already receiving Social Security payments when you become eligible for Medicare, you don’t need to apply. You will be automatically enrolled in Medicare. If you are turning 65 and not yet receiving Social Security, you need to apply. You can do so 3 months before the first day of the month that you turn 65.

How do I enroll in Medicare? 1. Apply Online through the Social Security website. 2. Call the Social Security Administration at 1-800-772-1213 and schedule an appointment to enroll by phone. Instead of calling the main Social Security 800 number, you can call your local office to schedule a phone enrollment. To find your local office click here.

What Penalties Can I Incur With Medicare? If you don’t enroll in Medicare Part B when you’re first eligible, and decide to enroll later, your monthly premium will include a penalty. Your penalty gets worse based on the length of time that you didn’t sign up. Penalties can be avoided if you maintain other insurance such as employer group medical. Veterans Administration benefits do not count as other coverage toward penalties.

What is the benefit of working with Medicare For Heroes? Medicare can be confusing and the government doesn’t directly provide you with all benefits. So, you have choices to make and things to do. As a top independent agency, we are a one stop guide and resource to help make your life easier. We can help you maximize your benefits and save money. There are also no fees or costs for you, it’s a win win.

Medicare Advantage Frequently Asked Questions

Will Medicare Advantage and it’s extra benefits cost me more monthly? In most cases no. The nice thing about Medicare Advantage is that you can get extra benefits included, for no extra monthly cost. In fact, in some cases you can get the extra benefits and lower your overall monthly cost (see Part B giveback below.)

What is Part B Giveback? Part B Giveback is a benefit of certain Medicare Advantage plans, and in particular, designed for those with Military or Veterans health benefits. In these cases the plan gives you money back, which lowers your overall monthly cost of Medicare. This could save you hundreds or even thousands of dollars per year. Part B giveback does not lower the quality of your coverage.

How does Medicare Advantage provide extra benefits for no extra monthly cost? When you sign up for a Medicare Advantage plan it is provided by a private insurance company and it becomes your Medicare benefits. Medicare then pays your insurance provider a monthly amount to provide you with your benefits. Insurance providers are already efficient at providing extra benefits (dental, vision, hearing, etc), so they’re able to include them for no extra cost.

Will having Medicare Advantage lower the quality of my coverage or care? No. Medicare Advantage is regulated by the federal government. Medicare Advantage plans provide coverage for medically needed care and treatment. However, the quality of service and doctor / hospital networks can vary with different plans and insurers. Request information with us and we’ll recommend good options for you.

If I sign up for Medicare Advantage, can I keep my doctors or will I need to change them? If you have VA benefits, you can continue with your current doctors at VA facilities & network providers. For military hospitals & clinics, as long as they agree, you can continue to use them. This is the same for Standard Medicare. For private / civilian doctors, in most cases, you will be able to keep seeing them. Medicare Advantage plans have networks, meaning a list of doctors and hospitals that are accept the plan. Some Medicare Advantage plans allow you to go out of network, to any doctor. When evaluating a Medicare Advantage plan, you should check if your doctors and medical providers accept the plan. If you’re working with us, this is something that we will do for you.

When can I enroll in a Medicare Advantage plan to get additional benefits? There are two primary periods when you can enroll in a Medicare Advantage plan. 1. When you first start Medicare A & B. 2. During the Annual Open Enrollment period which begins October 15th and lasts through December 7th.

How can I enroll in a Medicare Advantage plan? There are two primary periods when you can enroll in a Medicare Advantage plan. 1. When you first start Medicare A & B. 2. During the Annual Open Enrollment period which begins October 15th and lasts through December 7th. Contact us. We are able to review and enroll you over the phone in the plan you choose.

If I decide to take Medicare Advantage instead of Original / Standard Medicare, can I ever change back? Yes. Each year from January 1st through March 31st you can dis-enroll from a Medicare Advantage plan and go back to Original Medicare. You can also change from one Advantage plan to another during open enrollment from October 15th through December 7th each year.

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Guide Downloads

Click Here to download / print the Medicare For Heroes guide for Veterans, Retired Military, and their families.

Click Here to download / print the Medicare Choices Made Easy guide on the different parts and choices with Medicare.

Lone Star Medicare, LLC | Medicare For Heroes

7805 Cooper Ln. Suite #209
Austin, TX 78745
855-625-7633 Toll-Free Phone

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TX #2495139, AZ #3001852513, AR #3001409811 VA #147897, OH #1285673 TN #2475437, SC#3000813771, LA #867655, FL #11741456

As an independent agency specializing in plans for veterans and their families, we offer a carefully selected range of plans and insurers tailored to your needs. However, our offerings do not cover every plan available in your area, and the information we provide is specific to the options we do have. For a comprehensive view of all your options, we recommend visiting Medicare.gov or calling 1-800-MEDICARE. This approach ensures you have access to the widest selection of plans, allowing you to make the most informed decision about your healthcare coverage.