Ask the Medicare Specialist
This weeks new material will be featured in this Sunday 3/28 Edition of the Post-Gazette.
QUESTION:
From James: I’m a healthy 67 old Veteran living in Pittsburgh, but only learned this year that I’m eligible for VA healthcare and was recently enrolled. I also learned I can receive a discount on my Medicare Part B premium, and switch to a $0 dollar Advantage Plan geared toward Veterans. I currently have an Advantage Plan PPO that costs $30. My agent recommended a $0 HMO, but it has no prescription drug coverage. Prescriptions would have to come from the VA. I read in your January 30th article from last year that there were $0 Veterans plans with prescription benefits. Is such a plan still offered in 2021? If not, would adding a Part D plan to a Veteran’s plan make sense if I choose and stay with my current PCP and not use the VA? As for providers, I’ve become a little less satisfied with my long time PCP. On the other hand, I’ve heard good things about the Pittsburgh VA and would be willing to give them a try. I highly value your expertise and would greatly appreciate your advice.
ANSWER:
First let me say I believe Veterans deserve the best health care the country has to offer at no cost, including Medicare. They’ve earned it.
This is a great question and topic. I hear good things about the Pittsburgh VA as well. It’s come a very long way from 10 years ago, when the majority of Veterans I met didn’t want to get any services there. That isn’t the case anymore with the almost every Vet I speak with who say they’re happy with the Pittsburgh VA and enjoy going. My advice to all Veterans who qualify for benefits, even those who don’t choose to use the VA, is apply and keep them active. It’s a great thing to have in your back pocket and can be very useful in some circumstances, especially for certain brand name medications and insulin.
As far as getting your Part B discounted, that can only happen two ways. The first is restrictive because the state of Pennsylvania’s Medicare Savings Program (MSP), which pays 100% of Part B premiums, has income limits of $1436/ month for an individual and $1,940/month for a married couple. There are also asset limits as of $7,730 (single) and 11,600 (married) as well. A home, one automobile per household member, and personal possessions such as jewelry are not counted as assets. However, savings, checking, additional autos, non-residential property, retirement accounts such as IRA’s or 401K’s, stocks or bonds, and even the cash value of life insurance policies are. The other way to get a discount on Part B is to enroll in a $0 premium plan that provides a Part B reduction, or “give back” as it is often referred, of $40. There are two companies that offer them and one in particular was a very popular choice this Annual Election Period. It offers the lowest available Maximum Out of Pocket (MOOP) of any plan in Western PA, some of the lowest co-pays, the largest amount of comprehensive dental benefits, and the most generous OTC allowances. But as James mentioned, these plans don’t come with Part D prescription coverage so they’re designed for those who can get their prescriptions through what Medicare considers a “creditable” source such as the VA, PACE, or PACENET. Vets who use the VA for prescriptions often pay more for generic medications than those who have drug coverage through an Advantage Plan, with some offering $0 co-pays for both Tier 1 and Tier 2 generics, so choosing a plan without drug coverage may not be the best option.
There are $0 premium Advantage Plan HMO’s available that provide prescription drug coverage. However, they have a higher MOOP and co-pays for most services. This wouldn’t be as much of an issue for those who use the VA almost exclusively, which is sounds like James is open to at some point. Also, these $0 premium plans don’t offer nearly as good dental benefits as the plan he has now, nor do they provide as much OTC allowance. And unless you’re 100% service connected, the VA does not offer any dental. There are several factors that go into what Advantage plan a Veteran like James should choose. He may be best to take the $0 plan with the $40 Part B give back without drug coverage, possibly a $0 premium with drug coverage, or continuing to pay $30 for his current PPO may be the better choice. All the licensed agents at The Health Insurance Store can help determine which is overall most cost effective and beneficial for Veterans, as well any other Medicare beneficiary for that matter.
This following fact is extremely important. You can’t choose a $0 premium Advantage Plan and pair it with a separate Stand-Alone Part D plan like those who have Supplements utilize! Enrollment in a separate Part D plan would automatically trigger a dis-enrollment from an Advantage Plan an it’s not terribly uncommon for people to make this mistake.
Although out of the scope of the question, I want to make sure everyone understands that having an Advantage Plan in no way interferes with VA coverage. The VA simply bills the insurance company and then covers the co-pay that would have been due at a private hospital such as UPMC, AHN, or elsewhere, making medical services no cost for the Veteran when services are received at VA facilities. It’s my opinion that almost all Vets, even those who use the VA exclusively should have a $0 or low premium Advantage Plan rather than just straight Medicare for several reasons. Number one is having the choice of an affordable alternative to the VA if medically necessary or if that would be a preference. We’re very blessed to have two outstanding Pittsburgh area hospital systems who employ some of the top doctors in the country. Second is in an emergency where a Vet ends up in the back of an ambulance and at a hospital outside the VA. Having an HMO or PPO can eliminate the possibility of getting expensive bills and the headache of trying to get the VA to pay those claims. An ambulance ride and hospitalization for someone with Medicare only could easily cost $1,800 or more. Third is for convenience. Vets who live in rural areas such as Fayette County have an hour or longer drive to see a specialist in Pittsburgh that might only cost a $30 to $40 to visit locally. By the time you add up gas, tolls, and a lunch, it could come to that or more to go to the city. Not to mention, traffic near the VA can be stressful for those not used to driving in it. Lastly, as I mentioned previously, Advantage Plans have great ancillary benefits such as dental, OTC allowances, free gym memberships, and more, that the VA doesn’t offer.
It’s quite possible that Vets who currently have Medicare only can enroll still enroll in an Advantage Plan HMO or PPO or move to another that can provide better value. To inquire if you’re eligible, if you have any questions regarding this or any other Medicare topic, or to make an appointment for a no cost consultation, give us a call or email me personally.