VA Benefits and MA Plans

[Deacon]

I am new to the forum but from reading I am sure there will be plenty of information on the subject.

I have met with seniors that have VA benefits and some are concerned it will affect there benefits if they enroll in a medicare advantage plan as well. I was under the impression that they would have a choice as to where they could go to recieve their medical care.

Can anyone comment on how that works here in California and any documentation to support that I can show to VA members.

Thanks

Deacon

 

[GreenSky]

I have enrolled many vets into MA plans. There never is any issue with their VA benefits.

Rick

 

[Bob_The_Insurance_Guy]

I cannot speak for any other state, but here in Georgia, the VA picks who they coordinate benefits with, and as long as you select that company - or companies - to represent, you will be okay.

With one exception...


Stay away from anyone who has Tricare or Tricare for Life. That benefit is just as good, if not better, than any Medicare Advantage Plan out there.

I have some Vets on MA plans, and some on just PDP's. Always check with the VA as to what plans they work better with than others.

 

[Deacon]

But with Tricare, don't they have to fill out their own paperwork and pay for services up front. I thought the Secure Horizons Essential worked along with Tricare.

Deacon

 

[patch36]

No. Not that I have ever seen. Tricare is as good as it gets. Never mess with someones Tricare.

My father had Tricare and never paid up front for anything, and he went to a lot of different Drs and Hospitals during his life.

 

[Deacon]

Thanks for the input, is there any information online that I could show clients with VA benefits. I looked on the VA website and didn't find anything.

Deacon

 

[patch36]

In many cases the PD portion of the MAPD is better than what the VA provides. Lower co-pay and more drug choices. One area to be careful in is regarding the Coverage Gap. The VA does not have a coverage gap on Drugs and if the client is on a lot of Prescription Drugs you may be doing harm.

The MA portion dovetails fine with VA, but only if the client is paying co-pays for medical at the VA. Some do based on income, and if that is the case it can help. It also gives them the freedom to NOT use the VA, which in many cases is not convenient or nearly as close as non VA facilities. Every case is different and you have to weigh the pros and cons. I also depends on the MA, whether it is PFFS, PPO, HMO, POS, ect. and the network associated with the MA.

Doing the best thing for the client is the most important consideration, but it isn't always clear cut.

 

[arnguy]

In Pennsylvania, there is no problem enrolling vets in an MA even if they have the VA benefits. Normally the VA will coordinate care with the veterans private medical sevice. As far as Rx, IMO the VA drug program surpasses any Part D program I have seen. The copay is reasonable and will be waived in some cases if the vet qualifies (based on a "needs" application - Form 10-10Z). There is no cap and no doughnut hole in the VA Rx plan. Also, the available drugs on the formulary is huge.

 

[jdeasy]

I am new to the forum but from reading I am sure there will be plenty of information on the subject.

I have met with seniors that have VA benefits and some are concerned it will affect there benefits if they enroll in a medicare advantage plan as well. I was under the impression that they would have a choice as to where they could go to recieve their medical care.

Can anyone comment on how that works here in California and any documentation to support that I can show to VA members.

Thanks

Deacon

VA folks a fully dual elidgible. You can put them in an MA for them to use when they chose to not go to a VA Dr. or hospital. If they want to use the VA, the MA will not affect it at all.

You can also put a VA person into a part D. They can use it when they don't want to use the VA. They can still get their RX from the VA if they chose and not use their Part D.

As someone already said, don't put someone with Tricare on an MA. Tricare folks do not have to use the VA, they can go anywhere. It's like very good private insurance and you wouldn't put someone with private insurance on an MA.

As for having this in writing, go to the Medicare website and they have the PDF manual that you can download.

 

[Deacon]

Thanks for all the information.

Deacon