Fall under SEP. I think I know the answer (having MA keeps him from qualifying for a SEP) but can't find the answer. I was about to enroll him in UHC MA after he told me he was had just lost his VA cov'g, till I got on MC.gov and saw he had Texan Plus-said he forgot he had it as an agent enrolled him last yr and he's never used it as there were no Dr's around his area.
Does losing VA coverage, while covered under MA....
- Thread starter cador
- Start date
Why did he lose the VA? No longer active service?
Why did he enroll in Texan Plus?
If you have or can get both Medicare and Veterans' benefits, you can get treatment under either program.
When you get health care, you must choose which benefits to use each time you see a doctor or get health care. Medicare can't pay for the same service that was covered by Veterans' benefits, and your Veterans' benefits can't pay for the same service that was covered by Medicare.
Which insurance pays first | Medicare.gov
You can have both Medicare and Veterans Affairs (VA) benefits, but Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility.
Making Part B enrollment decisions with VA benefits - Medicare Interactive
Doesn't appear losing VA creates an SEP
Why did he enroll in Texan Plus?
If you have or can get both Medicare and Veterans' benefits, you can get treatment under either program.
When you get health care, you must choose which benefits to use each time you see a doctor or get health care. Medicare can't pay for the same service that was covered by Veterans' benefits, and your Veterans' benefits can't pay for the same service that was covered by Medicare.
Which insurance pays first | Medicare.gov
You can have both Medicare and Veterans Affairs (VA) benefits, but Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility.
- In order for your VA coverage to cover your care, you must generally receive health care services at a VA facility.
- In order for Medicare to cover your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
- VA benefits will not pay for Medicare cost-sharing (deductibles, copayments, coinsurances).
Making Part B enrollment decisions with VA benefits - Medicare Interactive
Doesn't appear losing VA creates an SEP
I think it is normally when there is no drug coverage besides VA as it is a loss of credible drug cov, I am pretty sure I read that somewhere, But I don't know that would have an effect if drug cov is already in place beforehand
JaBrooklyn
Expert
- 83
How would you lose VA benefits? Sounds like the client is confusing something....Was he active?
- 6,457
I believe some veterans can gain or loose access to the VA program based on income levels.
Not true at all. Income has nothing to do with the actual coverage. It does come into play sometimes with the drugs though and whether or not you have to pay the $8 co-pay.
I find it very hard to believe this guy just lost his VA coverage for no particular reason. It just doesn't happen.
- 6,457
There are 8 tiers of possible eligibility for va benefits, and I'm pretty sure some of those are tied to income.
(Edit--or at least actual access to VA services within tier eligibility is controlled based on applicant's income during times of constrained VA funding.)
Last edited:
- 6,457
Medigap plus PDP probably doesn't meet income/expense criteria of client, but if no docs in area, would you have a shot at claiming misrepresentation for MA plan and putting him on a GI medigap plus PDP?
(Caveat, please be aware that I am not an agent (also not a TX resident).)
I'm not talking about the tiers of eligibility. I'm talking about eligibility period. You won't be "kicked out" of the VA due to income, high or low. Income has nothing to do with the basic eligibility to receive care from the VA.
By the way, I am a disabled vet and I do receive car through the VA. The care I receive has never been tied to my income in any way shape or form. I do have a prescription co-pay and that is $8 per prescription. If my income was low enough I would be getting them for free.
- 6,457
Todd,
It will likely be next week before I am able to do so, but I will either document my comments or apologize for being wrong. I am not able to find the document I am looking for quickly in the time I have right now.
LD
I've found this but dont have the info I want to tie it to the tiers or more details.
