MA and VA Benefits

[Josh]

So if MA doesn't exist how does client get help with out of pocket costs at VA?
Also, what's the harm in a MA plan if the VA doesn't bill MA plan? Sounds like client can choose VA or MA providers

The VA healthcare system and the civilian healthcare system are two different critters. The VA is more of a clinic system that let's vets use their services at little or no cost. This has absolutely nothing to do with Medicare.

Let's say the vet has a heart attack, they aren't going to rush them to the VA hospital, they're going to get them to the nearest facility that can help them. If that is out of the VA system (or if the VA system was just full) then the vet is on the hook for the cost as if they had no VA benefits. If you have a client that uses the VA system exclusively and you have a zero premium MA plan with an inpatient hospitalization benefit that's better than Original Medicare, this is a slam dunk. Prospect keeps using the VA the same way they have, but if they need emergency services form a civilian facility or feel like using the civilian coverage network in the MA plan, they have that option. It does not impact their VA benefits at all. That's different than tricare or champus, but that's not what you were asking about.

My suggestion to everyone on this thread so far is to get to know the VA system. I think I did cover it pretty well here, but it's a big deal and if this is a market you run into at all, it's worth learning about. There are different levels of benefits they have, but if someone is referring to VA benefits then it's usually not tricare or champus. The VA benefits are just from the facility and they do not pay a premium for it or have anything outside of a copay. For all practical purposes, this has nothing to do with Medicare.

 

[WCMason]

MA plans without PD benefits where they get a Part B reduction are also popular with vets who get their meds through the VA.

 

[mikeincolumbuso]

I do enroll lots of vets. I had a case right after Part D started in 2006. This guy got an eye infection over the weekend was closed. His Optomolgist prescribed a liquid antibiotic that cost him over $200. The copay would have been $30 in a zero premium plan. Also, In many cases, the VA will pay for local charges if someone is admitted into the hospital and the VA is aware of it/authorizes it ahead of time and I have seen situations where the VA bills Original Medicare, but not MA plans. The MA plans help veterans if they choose to receive services from local providers. Also, if the veteran has co payments for their RX, they be able to get the RX cheaper from the MA plan. The trouble I have with veterans, when they do raise objections, is that they are very loyal to the VA. They served our country and they deserve to get their health care thru the VA. Others understand that VA services are not perfect and it makes sense to get the most out of their Medicare since they are already paying the Medicare Part B premium.