By Susan Stewart, Licensed Insurance Agent
Many veterans are unaware that they can be eligible for Medicare Advantage benefits, provided they have both Medicare Part A and Part B. This is important because while the Department of Veterans Affairs (VA) offers healthcare coverage, in my experience as a licensed insurance agent working with veterans, the care it provides is highly variable. Some veterans have access to nearby facilities with stellar care. In contrast, others must use facilities far from home or receive care so minimal (due to eligibility or the facility itself) that using the VA isn’t logical.
Here are a few potential disadvantages of relying only on the VA for care:
- Your closest VA is too far away, or getting an appointment is difficult.
- Providers rotate, so you may not always see the doctor you prefer.
- The VA formulary for drugs is narrower than Medicare formularies.
- Very few people on VA coverage can get dental, vision, and hearing care.
- You may face copays for doctors or specialists.
- Hospital charges can vary.
- There’s no maximum out-of-pocket limit.
Medicare Advantage plans can be a resource to mitigate some of these limitations. Although Medicare Advantage plans are county-specific and vary widely across the country, some potential benefits for veterans include:
- More convenient access to a network of doctors, specialists, and facilities.
- Larger variety and lower cost of medication.
- Dental, vision, and hearing benefits.
- Lower copays.
- Transportation to and from medical facilities.
- Maximum out-of-pocket limits.
- $0 basic gym memberships.
- Over-the-counter drug benefits.
I frequently help veterans when they receive all their medication through the VA. Medicare Advantage plans are intended for veterans who do not need RX coverage. They can include some level of Part B giveback; provide dental, vision, and hearing coverage, provide over-the-counter benefits, and offer a second and separate option for healthcare when the VA isn’t convenient.
VA benefits and Medicare benefits do not coordinate, so veterans on Medicare must choose whether to use the VA or their Medicare plan. The veteran needs awareness of how their VA coverage works to decide whether to use their VA coverage or Medicare. This isn’t something an insurance agent can know or find out, so it’s always a good idea to inform the VA when you add a Medicare Advantage plan.
Veterans should also factor whether they’re part of the CHAMPVA and TRICARE for Life programs into their decision-making. While part of the VA, these programs are very different from each other and from standard VA benefits. A Medicare Advantage plan can still offer additional benefits for people enrolled in these programs, but this requires a thorough understanding of the challenges and advantages. An insurance agent must be well-trained, knowledgeable, and experienced to adequately assist those with CHAMPVA and TRICARE for Life.
If you are a Veteran, thank you for your service, sacrifice, and family sacrifice. May God bless and keep you.
