Ask the Medicare Specialist
QUESTION:
If one has VA benefits, how does that figure into which Medicare plan to consider? I’ll be turning 65 in August and am starting to investigate all my options.
ANSWER:
Having access to the VA can absolutely play a role in what type of plan you choose.
We advise clients who use our services and qualify for VA medical and prescription benefits to choose either an Advantage Plan HMO/PPO or a Supplement. We don’t see any benefit of going with Original Medicare and the VA only.
My experience with Veterans on Medicare is there are two types: Those like my father, who prefer to get virtually all care at VA facilities. And those who want little or nothing to do with the VA. I recommend a $0 or other low premium Advantage Plan to those who prefer to get most or all their care at the VA. “Why would I need another plan if I get all my care at the VA hospital,” is what I’ve been asked by Veterans on numerous occasions. Number one, having an HMO or PPO in no way interferes with or disrupts VA coverage or benefits. Secondly, there are several plans that cost nothing which can be very helpful in the event of an emergency. Medicare only covers 80% of an ambulance ride or a trip to the Emergency Room. If a Vet broke a bone and had a $2,000 ambulance ride and a $4,000 ER visit, the 20% he or she would be responsible for comes to $1,200. With the HMO we normally advise our VA clients to take, that bill would be reduced to under $300. I realize the VA has gotten better about approving ER visits and other care outside of their facilities. However, there are scenarios where they won’t pay. In addition, the VA can be a bureaucratic nightmare. It can take hours upon hours on the phone and literally months to get a bill processed. In the meantime, the hospital and ambulance service want paid and could become inpatient and report you to collections.
Freedom to choose providers is another reason I believe Vets need an Advantage Plan vs straight Medicare. While the VA is doing a good job as a whole, taking care of our Veterans, there may be some limitations on what kinds of treatment they can provide or quality of certain services. When it would come to Cancer, one may want to utilize UPMC or Allegheny Health Network, who have outstanding reputations for Oncology. UPMC was recently ranked 7th in the nation by US News and World Report. In addition, two of the most popular Advantage Plans in Western PA now provide network access to the Cleveland Clinic, which could be lifesaving. And most $0 premium plans come with prescription benefits. So, in the event you need to pick up a medication immediately, you can without waiting. And copays on generics are often $0 vs $8 at the VA. For someone who takes five or more generics that could be a savings of $500 or more per year. Another reason those who have VA benefits go with a $0 or low-cost premium Advantage Plans is for convenience. This is especially true for Veterans who live in more rural areas. It’s an hour drive to the Pittsburgh VA from Fayette County, where our original office is located. If one of our local Vets needs to see a specialist, he or she would most likely have to go into the city. Between gas, tolls, and buying lunch, the costs could add up, not to mention the time the round trip takes. That Vet could see a local specialist for as little as $30 if he or she had an Advantage Plan.
I’m much more likely to recommend Advantage Plans to someone who has VA benefits than I am to those who don’t because utilizing the VA for chemo, radiation, skilled nursing, durable medical equipment, prosthetic devices, and hospitalizations eliminates the high co-pays for those services with Advantage Plans.
Lastly, Advantage Plans offer ancillary benefits that the VA doesn’t or only provides to those who are 100% “Service Connected.” These include dental, gym memberships, and Over the Counter allowances, among others.
Supplements are generally the choice for Veterans who don’t want to get much of their care, if any at all from the VA. Supplements generally cost more than Advantage Plans but eliminate almost all medical bills. Also, there are no networks to deal with for those who have Supplements. Every private medical hospital in the country is accessible as well as virtually every doctor. Please be advised, I never recommend a Veteran let their benefits lapse!
For questions regarding this or any other column, or to make an appointment for a no cost consultation to go over plans that work well for those with VA benefits, call one of our offices. If you would like to submit a question or get in touch with me personally, email aaron@getyourbestplan.com.