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Medicare Advantage and VA Benefits

Veterans who receive benefits often feel like they have to choose between purchasing a Medicare Advantage plan and getting health insurance coverage from their VA benefits. However, Medicare Advantage plans issued by reputable carriers can be a complement to VA benefits. It does not have to be an either or question but rather a question of how to get the best possible and fullest coverage for those who have served our country.

A Medicare Advantage plan can offer more options for care than the VA does because there are more options for plans and more institutions and doctors to choose from. These options could be closer to home and even more cost effective. Some veterans may even be eligible for Medicare Advantage plans that have $0 premiums and offer what VA benefits do not, like dental care. By choosing a plan that includes prescription drug coverage, some veterans may even be able to use their local, in-network pharmacy.

Reducing Gaps

While all Medicare Advantage plans work to reduce gaps in healthcare coverage, there are certain plans that were designed for veterans specifically, including those using their VA benefits. The Humana Honor Medicare Advantage plans, for example, offer additional benefits such as a $0 premium and dental care, which compliments the VA benefits while working to get veterans the care they need.

Choosing a Plan

Choosing an MAPD in addition to VA coverage is particularly beneficial for prescription drug coverage. While the VA does cover prescriptions written by a VA doctor and would continue to do so after the veteran enrolls in their Medicare Advantage plan, there are some things they will not cover. These include some types of injectables and infusion medications. A Medicare Advantage plan with prescription drug coverage would cover those medications if prescribed by an in-network doctor.

Medicare Advantage and VA Benefits – TRICARE and CHAMPVA

Medicare Advantage plans can also work with TRICARE and CHAMPVA. If a veteran who is covered by either of those decides to enroll in a Medicare Advantage plan, that plan will then become their primary coverage. This would require that the beneficiary see in-network providers. If a veteran using TRICARE or CHAMPVA does not mind being limited to a network of providers and can coordinate billing, considering enrolling in a Medicare Advantage plan may help them reduce gaps in coverage and cover more of their healthcare needs closer to home.

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I get a lot of questions about the various Medicare penalties and how much they cost.  I will summarize them here and then provide a link to a site which provides the specific detail.  Here is the overview.

Everyone who qualifies for Medicare does not need to pay for Part A of Medicare.  Some people do not qualify for part A and they need to pay a premium if they want the coverage.  For them, part A costs $451 a month but for most people it costs $0

Medicare Part B costs $99.90 a month for most people.  It can cost less for some people and more for higher income earners.  For example, an individual making over $85,000 a year will pay $139.90. The scale tops out at $319.70 a month for those that make over $214,000 a year.

If you sign up late for part B, you will pay a 10% penalty for every 12 months you didnt have part B, for life.   If you are over age 65, actively working and getting health coverage, you do not need to sign up for part B.  If you are not actively working and getting retirment coverage over the age of 65, you should sign up for part B because the penalty will count for you.

There are two Part D penalties.  The first is for those that sign up late for part D drug coverage.  The penalty is 1% of the average premium for every month you do not have a part D plan.  The average premium is about $31.00 a month which puts the penatly at about 30 cents for every month you do not have a plan.  The penatly never goes away.

There is also a Medicare Part D income penalty.   The penalty starts at about $11.00 a month for those that make over $85,000 a year.  It is added on to the insurance plans premium every month.   Here is a grid of the penalty levels

CMS has a very good page which summarizes this information.  You can see it by clicking here.