PDP ?

[toc3]

Good morning all,

I have a 71 yo male whom has been continuously covered through VA for his meds. He has put off enrolling into a supplement and a pdp due to having coverage through his employer while retired and wanted to keep that so that his wife also had coverage until she turned 65. She is now in her OEP and is enrolling into a supp and pdp. Mr. has also enrolled into a supp, doesn't want to be confined to VA only. My question is since he currently has va med coverage for prescriptions prescribed from VA docs, would it not still be in his interest to have a pdp for prescriptions prescribed by doctors outside of the va?

 

[scottfree]

Good morning all,

I have a 71 yo male whom has been continuously covered through VA for his meds. He has put off enrolling into a supplement and a pdp due to having coverage through his employer while retired and wanted to keep that so that his wife also had coverage until she turned 65. She is now in her OEP and is enrolling into a supp and pdp. Mr. has also enrolled into a supp, doesn't want to be confined to VA only. My question is since he currently has va med coverage for prescriptions prescribed from VA docs, would it not still be in his interest to have a pdp for prescriptions prescribed by doctors outside of the va?

I have about 10 VA members that are using a PDP outside the of their VA benefits. Some on a MAPD -They just use the VA and no supp. These clients are using it as an extra option, they use the VA for yearly checkups and The MAPD when they don't want to drive to VA hospital. They are on the Wellcare Concert and it has $0 for generics. I have another that has 10 medications from the VA and pays $8 for each drug so he has a PDP that he pays $20 a month and gets his 10 meds for $0 so he saves $60 a month. The VA for the most the most part doesn't cover name brand drugs so I have a few that joined a PDP to save sometimes 50% on a medication.

Each VA member is unique and the decision is up to them but they can enroll any year in the future without a penalty during AEP so unless they have a drug not covered by the VA most cases I would say no there is not much use to join. If they do go to a non VA doctor and get a drug they will have to go to the VA to get it through them.

For the most part IMO I would say there there not many reasons to join a PDP if they still go to a VA hospital and its not to far away.

Hope I don't have you totaly confused

Scott

 

[toc3]

I don't have much experience with va members either. So, if a non va doc prescribes a med, a va member can have it filled at the va? Do I also understand that a va member can enroll any year in the AEP due to the fact that the member would be considered to have creditable coverage?

 

[scottfree]

I don't have much experience with va members either. So, if a non va doc prescribes a med, a va member can have it filled at the va? Do I also understand that a va member can enroll any year in the AEP due to the fact that the member would be considered to have creditable coverage?

If it is a non VA doc he would have to go to the VA and see a doc to get the VA to fill it.

If he goes to the VA and gets a med he can get a copy to get it filled elsewhere. VA meds are for the most part $8 so they could take it to Wal-Mart or Walgreens and get it for $4 if it is on their list of discount meds.

And yes, a VA member will never have a penalty because it is considered creditable coverage. They only can join during the AEP. If they got a med such as Requip (RLS, Parkinsons) or Namenda (alzheimer's) which I believe are not covered by the VA and are expensive, mid year they could join in Nov. and not have a penalty.

 

[jdeasy]

I don't have much experience with va members either. So, if a non va doc prescribes a med, a va member can have it filled at the va? Do I also understand that a va member can enroll any year in the AEP due to the fact that the member would be considered to have creditable coverage?

Be careful with calling everything VA. There are a myriad of coverages under the VA umbrella, Champis, etc.

If a person just has the normal VA benefits where they can go to a VA clinic for medical services and get their RX from the VA, they may want to buy a stand alone PDP just for convenience. They must be buying part B in order to buy a stand alone PDP. They are not an SEP by just having the standard VA coverage. They can only buy a stand alone PDP during AEP.

 

[scottfree]

Be careful with calling everything VA. There are a myriad of coverages under the VA umbrella, Champis, etc.

If a person just has the normal VA benefits where they can go to a VA clinic for medical services and get their RX from the VA, they may want to buy a stand alone PDP just for convenience. They must be buying part B in order to buy a stand alone PDP. They are not an SEP by just having the standard VA coverage. They can only buy a stand alone PDP during AEP.

Just a little correction, they do not have to have part B to get a PDP. They only need to have part B if they want a MAPD.

 

[jdeasy]

Just a little correction, they do not have to have part B to get a PDP. They only need to have part B if they want a MAPD.

Noted.

 

[theinuranceguy]

I do not believe that the VA is considered credible coverage. So for every month your client was not enrolled in a Part D, he will be penalized for that, 1% added to his premium (of the national average).

So even if you decide to put him in a zero premium MAPD (Which most my VA clients are on) he may have a premium per month of a couple dollars.

 

[scottfree]

I do not believe that the VA is considered credible coverage. So for every month your client was not enrolled in a Part D, he will be penalized for that, 1% added to his premium (of the national average).

So even if you decide to put him in a zero premium MAPD (Which most my VA clients are on) he may have a premium per month of a couple dollars.

VA is considered creditable coverage.

Most entities that currently provide prescription drug coverage to Medicare beneficiaries, including VA, must disclose whether the entity's coverage is "creditable prescription drug coverage."

• Enrollment in the VA health care system is creditable coverage. This means that VA prescription drug coverage is at least as good as the Medicare Part D coverage.
• Because they have creditable coverage, veterans enrolled in the VA health care program who choose not to enroll in a Medicare Part D plan when they are first eligible for Medicare Part D ("initial enrollment period") will not have to pay a higher premium on a permanent basis ("late enrollment penalty") if they enroll in a Medicare drug plan during a later enrollment period.
• However, if you disenroll in VA health care or if you lose your enrollment status through no fault of his/her own (such as an enrollment decision by VA that would further restrict access to certain Priority Groups), you may be subject to the late enrollment penalty unless you enroll in a Medicare Part D plan within 62 days of losing your VA coverage.
• If you are a veteran who is or who becomes a patient or inmate in an institution of another government agency (for example, a state veterans home, a state mental institution, a jail, or a corrections facility), you may not have creditable coverage from VA while in that institution. If you think this applies to you, please contact the institution where you reside, the VA Health Benefits Service Center at 877-222-VETS (8387), or your local VA medical facility.

http://www.va.gov/healtheligibility/costs/MedicareD.asp

 

[toc3]

Thank You Scottfree, I will talk to my prospect today and give him his option of enrolling come Nov. 15th. I appreciate the info.