This week’s question from Paul
I’m a Veteran and get all my care at the Pittsburgh VA. Many of my friends have Medicare Advantage Plans and keep telling me I should enroll in one as well, but I’m a bit skeptical. I’m afraid I might lose some of my VA coverage or access. What are the pros and cons of me enrolling in an Advantage Plan for next year?
Answer
No Interference with the VA
I advise almost all Veterans in Paul’s situation to enroll in an Advantage Plan HMO or PPO. And let me make this clear. Having one in no way interferes with VA coverage and benefits. There are so many good reasons for Veterans who have original Medicare Parts A and B only to enroll in one. Let’s go over them.
Lower Costs
The plans we recommend most for Veterans don’t cost anything! In fact, there are now a handful designed for Vets that actually refund a portion of their Medicare Part B premium, up to $50 per month. That means, in a sense, Veterans are being paid $600 per year to have an Advantage Plan. I know it sounds crazy. When I first got into the Medicare field 14 years ago and was told I’d be paid a generous commission to enroll people in Medicare plans that had no cost, I couldn’t believe it. Then it was explained to me that Advantage Plan companies are subsidized by Medicare to the tune of almost $10,000 per year per enrollee. They can afford to offer $0 premium plans and still make a profit. And today, with the competition so fierce amongst companies, they’ve taken it a step further with the Medicare “Give Back,” as the refund is sometimes referred to. One of the best Advantage Plans on the market provides it.
Coverage Picks Up Where the VA Doesn’t
Advantage Plans we advise Veterans to enroll in provide benefits the VA doesn’t or only gives to those who are 100% service connected like comprehensive dental that covers cleanings, x-rays, fillings, crowns, root canals, extractions, and dentures. They also provide Over the Counter (OTC) allowances that can be used for vitamins, pain relievers, cough and cold remedies, oral hygiene products, compression socks, first aid, and even sunscreen and mosquito repellent! Those on plans that provide OTC benefits simply order what they want out of a catalog, up to their quarterly allowance (over $100 on some plans), and they are then delivered by mail at no cost. In addition to dental and OTC, there’s also the Silver Sneakers free gym membership and two weeks of prepared meals supplied after a hospital or Skilled Nursing stay.
Savings on Medications
Many Veterans can save a significant amount of money on medications. Most pay $8 for a 30-day supply and $24 for a 90-day supply of generic drugs through the VA. Advantage Plans that have Part D drug coverage supply Tier 1, and possibly Tier 2 generic medications for $0. Someone taking five or six medications at $40 to $50 per month could get them at no cost on many Advantage Plans. There is a plan available that has drug coverage as well as the Medicare “Give Back.”
Choice, Convenience, and Guarantee
HMO’s and PPO’s provide Veterans choice, convenience, and a guarantee of payment if a trip to a non-VA emergency room is necessary.
Although the Pittsburgh VA has become an excellent provider of medical care, there could be a situation where they may not be able to provide a service or have the technology our two major health care systems in Western PA do. For those with Medicare only, care or services at a facility outside the VA could be extremely expensive. A good Advantage Plan can keep those costs to a minimum.
The convenience factor isn’t as big of a deal for those who live in Pittsburgh, or very close by, and can access the VA hospital easily. However, those from more rural areas such as Fayette or Somerset County have an hour or longer drive to see specialists or get testing or treatments that aren’t available at their local clinics. Specialist visits on Advantage Plans are as little as $30. It may be much easier and even less expensive for someone to see a local doctor than driving into the city, paying tolls, using gas, buying lunch, and dealing with traffic and parking. In addition, the most popular Advantage Plans among our clients provide network access to the Cleveland Clinic, one of the best hospitals in the world. I know several people who have had their lives saved there.
Those who have Medicare only and end up in the emergency room outside of the VA can be responsible for expensive bills. The VA has gotten a bit better about helping with those costs over the last few years. However, their rules regarding reporting an emergency are pretty strict and if not followed, reimbursement won’t be made according the VA website. And even if you do all they require, the VA can be a nightmare of bureaucracy. Speaking to the right person about getting a bill paid can be extremely time consuming and frustrating. It’s far less burdensome financially and mentally for those with Advantage Plans. Take this example: A Vet with just Medicare Parts A and B falls and breaks a leg and has to take an ambulance to the emergency room. The ride costs 20% of the billable amount to Medicare. If that was $2,000, the Vet’s responsibility would be $400. A broken bone treated at an emergency room is billable at around $7,000. Again, Medicare Part B only covers 80% of outpatient procedures, including an emergency room visit, so the remaining 20% comes to $1,400. A Vet with an Advantage plan would pay as little as $125 co-pay for the ambulance ride and only $90 for the emergency room visit. That’s $1,500 less than someone with Medicare only.
What are the reasons for someone with VA coverage not to have an Advantage Plan? There aren’t many. Those who have a Supplement don’t need an Advantage Plan. And you actually aren’t allowed to have both an HMO or PPO and a Supplement. I really can’t think of any other reasons why it wouldn’t be a good idea.
I’m surprised how many Veterans have Medicare A and B only. I think there’s a fear factor, like Paul expressed in his question. I’ve discussed that in so many columns, senior citizens afraid of change. There’s no need to be fearful of enrolling in an Advantage Plan in addition to VA coverage. Again, it does not interfere with care veterans receive at any VA facility. It’s one of the easiest decisions ever in my opinion.
Those with CHAMP VA and TRICARE can also add and Advantage Plan for the extra benefits they provide.
Thank you!
If any of our Veterans or their family members have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be honored to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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