OEP & VA Question
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I am not old enough or disabled so I do not qualify for Part D. I do qualify for VA Medical & Prescription Drug Benefits because of qualifying Military service. Yes, there are some formulary restrictions, but when I have needed an exception, I have gotten it. In most cases generic drugs are used.
I pay $8 a month per prescription. I pay no monthly premium and there are no gaps in coverage. I am not aware of any restrictions regarding ER and prescription drugs and would also be interested in what has been referred to in a previous post.
I pay $8 a month per prescription. I pay no monthly premium and there are no gaps in coverage. I am not aware of any restrictions regarding ER and prescription drugs and would also be interested in what has been referred to in a previous post.
That's what I was trying to say. I'm also a Vet, and I have a 20% disability with them. There are only 3 categories that I am aware of...Tri-Care for Life, VA disability, and last but not least, for those just getting out of the military for X amount of time ( I think that is about 2 years). Other than that, I know of no other Non-Tri-Care category. As for the meds...hey, they're $8 bucks per prescription unless you qualify for lower income and then they are $0. The VA is credible coverage when it comes to the drugs so....YES, you can change them!
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So the real question should be;
If a Medicare Eligible Level 8 Vet is considering dropping his PartD coverage, does the insurance agent advise the vet of potential limitations?
I say yes!
I also sell Part D plans to Level 8 Non-TriCare For Life Vet's!
ER drugs have been discussed before...
If a Medicare Eligible Level 8 Vet is considering dropping his PartD coverage, does the insurance agent advise the vet of potential limitations?
I say yes!
I also sell Part D plans to Level 8 Non-TriCare For Life Vet's!
ER drugs have been discussed before...
I know this is going to tax the brains of some of you, but here is the scoop: (and stop jawing between each other... look it up!)
On the issue of VA benefits and Medicare Part D---
Information for Veterans About the New Medicare Prescription Drug Benefits (VA Health Care Eligibility & Enrollment)
On the issue of VA benefits and Medicare Parts A and B---
Information for veterans eligible to enroll in Medicare (VA Health Care Eligibility & Enrollment)
And all other issues regarding VA Benefits---
Current Benefits - Public and Intergovernmental Affairs
And last, but not least, the difference between CHAMPUS (TRICARE) and CHAMPVA---
CHAMPVA - Health Administration Center
As for the question that was never asked.... about CHAMPVA, here is a little tidbit from the available info in the link above:
Overview
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by Health Administration Center and our offices are located in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS) the two are often mistaken for each other. CHAMPVA is a Department of Veterans Affairs program whereas TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. In some cases a veteran may appear to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary... you can´t choose between the two.
Medicare Impact
CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following conditions:
Ø if the beneficiary was 65 or older prior to June 5, 2001, and was otherwise eligible for CHAMPVA, and was entitled to Medicare Part A coverage, then the beneficiary will be eligible for CHAMPVA without having to have Medicare Part B coverage.
Ø if you turned 65 on/or before June 5, 2001, and have Medicare Parts A and B, you must keep both Parts to be eligible.
Ø if you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Parts A and B to be eligible.
Note: you are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.
A freebie: The VA is opening up Priority Group 8 (which many of us do not qualify for now because it was closed back in 2003) about June of this year. It is a means tested (income and asset) program. You might offer this info to your clients that are veterans and have not enrolled previously.
VA Health Care Eligibility & Enrollment
Lt. retread, USNR (ret.)
- - - - - - - - - - - - - - - - - -
It just so happens I had an appointment with a vet today. I advised him that enrolling in a MAPD plan would not prevent his participation in his VA benefits, but conversely would offer him some options he would not otherwise have. It is not necessary, but could come in handy. A lot depends on the level of service at the local VA hospital, and the distance to travel there and back versus closer PPO network providers, and prescription benefits.
The point is, that a MAPD plan COULD be useful. It COULD offer additional options. He also COULD just stay with Original Medicare with his VA benefits. Like anything else in life, you have to consider the cost/benefit ratio. In the case of $0 Premium MAPD plans, it is not unaffordable.
(What I did not realize until I researched the item above, was that VA will bill a Med Sup carrier, but not Medicare!)
On the issue of VA benefits and Medicare Part D---
Information for Veterans About the New Medicare Prescription Drug Benefits (VA Health Care Eligibility & Enrollment)
On the issue of VA benefits and Medicare Parts A and B---
Information for veterans eligible to enroll in Medicare (VA Health Care Eligibility & Enrollment)
And all other issues regarding VA Benefits---
Current Benefits - Public and Intergovernmental Affairs
And last, but not least, the difference between CHAMPUS (TRICARE) and CHAMPVA---
CHAMPVA - Health Administration Center
As for the question that was never asked.... about CHAMPVA, here is a little tidbit from the available info in the link above:
Overview
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by Health Administration Center and our offices are located in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS) the two are often mistaken for each other. CHAMPVA is a Department of Veterans Affairs program whereas TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. In some cases a veteran may appear to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary... you can´t choose between the two.
Medicare Impact
CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following conditions:
Ø if the beneficiary was 65 or older prior to June 5, 2001, and was otherwise eligible for CHAMPVA, and was entitled to Medicare Part A coverage, then the beneficiary will be eligible for CHAMPVA without having to have Medicare Part B coverage.
Ø if you turned 65 on/or before June 5, 2001, and have Medicare Parts A and B, you must keep both Parts to be eligible.
Ø if you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Parts A and B to be eligible.
Note: you are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.
A freebie: The VA is opening up Priority Group 8 (which many of us do not qualify for now because it was closed back in 2003) about June of this year. It is a means tested (income and asset) program. You might offer this info to your clients that are veterans and have not enrolled previously.
VA Health Care Eligibility & Enrollment
Lt. retread, USNR (ret.)
- - - - - - - - - - - - - - - - - -
So the real question should be;
If a Medicare Eligible Level 8 Vet is considering dropping his PartD coverage, does the insurance agent advise the vet of potential limitations?
I say yes!
I also sell Part D plans to Level 8 Non-TriCare For Life Vet's!
ER drugs have been discussed before...
It just so happens I had an appointment with a vet today. I advised him that enrolling in a MAPD plan would not prevent his participation in his VA benefits, but conversely would offer him some options he would not otherwise have. It is not necessary, but could come in handy. A lot depends on the level of service at the local VA hospital, and the distance to travel there and back versus closer PPO network providers, and prescription benefits.
The point is, that a MAPD plan COULD be useful. It COULD offer additional options. He also COULD just stay with Original Medicare with his VA benefits. Like anything else in life, you have to consider the cost/benefit ratio. In the case of $0 Premium MAPD plans, it is not unaffordable.
(What I did not realize until I researched the item above, was that VA will bill a Med Sup carrier, but not Medicare!)
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So the real question should be;
If a Medicare Eligible Level 8 Vet is considering dropping his PartD coverage, does the insurance agent advise the vet of potential limitations?
I say yes!
I also sell Part D plans to Level 8 Non-TriCare For Life Vet's!
ER drugs have been discussed before...
Sorry. I missed the ER drug discussion that has been discussed before and have not located it with a search, so I have no idea what has been discussed before. I guess I will take your statement for face value that there is some kind of implied problem with the VA and ER drugs.
I agree that as an agent you have to discuss the limitations of the VA drug program. I have clients who have Part D because of the limitations, mainly they cannot get certain name brand drugs through the VA that their civilian Dr has prescribed, and... if the Veteran is on very many Prescription Drugs, and they are mostly generic, and the Veteran is paying the $8 VA Copay per month, the Veteran can get the Prescription Drugs cheaper in some cases through a Part D plan at the local pharmacy.
There are several variable that have to be taken into consideration. CoPays, availability of name brands, Coverage Gap, and if I knew what it was I would also mention the implied problem associated with the ER.
I have never had a VA qualified Veteran drop his Part D once he was on it. It could happen I suppose.
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Sorry. I mussed the ER drug discussion that has been discussed before and have not located it with a search, so I have no idea what has been discussed before. I guess I will take your statement for face value that there is some kind of implied problem with the VA and ER drugs.
I agree that as an agent you have to discuss the limitations of the VA drug program. I have clients who have Part D because of the limitations, mainly they cannot get certain name brand drugs through the VA that their civilian Dr has prescribed, and... if the Veteran is on very many Prescription Drugs, and they are mostly generic, and the Veteran is paying the $8 VA Copay per month, the Veteran can get the Prescription Drugs cheaper in some cases through a Part D plan at the local pharmacy.
There are several variable that have to be taken into consideration. CoPays, availability of name brands, Coverage Gap, and if I knew what it was I would also mention the implied problem associated with the ER.
I have never had a VA qualified Veteran drop his Part D once he was on it. It could happen I suppose.
This is a very interesting discussion. We had a situation last year during the OEP. The man showed up with Original Medicare, and VA Drug coverage, with no Part-D. He needed Medical and Part-D help, so we put him in a MAPD.
Even though he had Creditable Coverage through the VA, he was not allowed to add a Part-D Drug Plan. The rule is you cannot add or subtract a Part-D during the OEP.
We didn't like it, he didn't like it, but that was the way it was.
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