MA and VA Benefits
- Thread starter jmarkk1
- Start date
- 2,370
The VA and the client's MA should not mix. MA and Medigap plans do not work with the VA.
Side note:
This is why some Vets use the VA for their drugs as it will not count against their coverage gap.
Side note:
This is why some Vets use the VA for their drugs as it will not count against their coverage gap.
I hope, more experienced agents can post a better explanation. Veterans enrolled in Medicare Advantage plans often find the civilian facilities convenient by location compared to the Veteran Clinic/Hospital etc. including pharmacies. Medicare Advantage locations as you know, may include both in and out of Network locations and may require referrals. Having a PCP, and RX pharmacy close to home on a MAPD may be all the motivation for enrolling and leaving the 'big stuff' for the VA facility to treat.
Personally, I have never seen a VA facility accept a Medicare Advantage plan unless provider agrees to coordinate treatment for a chronic condition closest to the Veteran's home.
Inpatient admission or an ER visit is more economical on a MAPD, which the VA will coordinate reimbursements under Utilization. The MAPD admission co-pays are more economical too.
VA benefits/services received by a VA facility/Provider and costs associated for such, are arrangements between the veteran and VA Administration. It may be 20%, a sliding scale or a disability Provider with Medicaid level co-pays only. To get them the best coverage and plug all the exposure possible for out of pocket costs, allot of questions have to be answered, with different sources are in each state.
Disability and VA coverage may include Medicare Advantage (SNP Dual or non) in which co-insurance may be comprehensive (meaning little to no out of pocket co-pays.) but difficult to explain to your client and navigate. It's a bit of phone work to coordinate alliances for veterans for a plan of care, but so worth it.
Sorry for the long post and hope this helps a little. IMHO- the networks in MAPD's are much richer benefits than VA services alone.
- Thread starter
- #4
Just like any other out of network provider on a PPO plan. The co-pays would be higher but the plan would pay VA the out of network reimbursement rate per procedure. The co-pays will be listed in the Summary of Benefits for the plan for both in and out of network. I think for PCP & Specialists visits are just $ 10 more for oon providers with that plan... the only real big exposure is for In-patient Hospital stays @ 30% co-pay. VA isn't going to chg a Vet that amount I wouldn't guess.... but just a WAG.
- 2,370
I can only speak for the VA in Kansas City, but they do not coordinate benefits with MA plans. The VA has tried in the past to bill carriers for services but the carriers just reject the bills.
- 2,177
That's my understanding, too. When using VA services the MA doesn't exist as far as they're concerned.
- Thread starter
- #9
- 2,177
No harm in a vet with VA benefits having an MA for civilian medical care. I've got many vet MA clients who use the MA as an alternative to the VA. But that MA plan won't cover any out-of-pocket costs at the VA. That's what my vet clients tell me, anyway. But they also don't complain about VA out-of-pocket costs being very much at all.
