As an Insurance Agent, I regularly get asked about veterans, veteran benefits and people who qualify for Tricare for Life and even ChampVA. The question always comes up "can I sign those beneficiaries up for Medicare Advantage plans?" The quick answer to that is yes, but like any other client that you have, I always suggest to do a complete and total needs assessment for those particular clients.
People Who Qualify For Veteran Benefits
Let's start with veterans. I think that's probably the the biggest demographic that we run into in the veteran world; people who qualify for VA benefits. Those are people who have served in the military at some time and have qualified to be able to go to a veteran facility for medical services and even prescription drug coverage. Those particular clients can really have the best of both worlds. I know a lot of carriers right now have MA only plans that they really market to veterans for a lot of those. MA only plans, of course, do not include drug coverage, so the assumption is that your veteran is filling their prescriptions at a VA facility and getting the prescriptions that way.
An Insurance Agent will offer them an MA only with what I call "bells and whistles"; a lot of extra benefits that those veterans really look for, such as dental, vision, transportation, and fitness programs. Your veterans might really like an empty plan, a Medicare Advantage plan that includes drug coverage.
I know here in the state of Alabama where I live, some areas are extremely rural, so it's very difficult for those veterans to access a VA facility and to get their prescriptions on a regular basis. An MAPD plan would really open up the opportunity for them to be able to go to providers and pharmacies that are closer to them instead of go into a VA facility. They still have that option to go to a VA facility and utilize those benefits there, but also that MA or MAPD plan would give them even more options in that more rural area. Also, for your veterans doing an MA or MAPD plan, it would give them the option to get a second opinion.
Maybe they went to the VA and really want to get another opinion outside of the VA to see if maybe they had a diagnosis that they're concerned about or just really overall want to get a second opinion. Those are just two scenarios of where an MA or MAPD plan could be very beneficial to your veteran client. But again, do a needs assessment, just like anybody else.
Most of your MA only plans are PPO plans, so it allows them to go in or out of networks are very flexible. Some of the MAPD plans that are in their area might be HMO. So make sure that the doctors and hospital they want to use would be part of that program.
Medicare Advantage Plans for Veterans
Most of your MA only plans are PPO plans, so it allows them to go in or out of networks are very flexible. Some of the MAPD plans that are in in their area might be HMO. So make sure that the doctors and hospital they want to use would be part of that program. Just like any other beneficiary, I think definitely do a needs analysis and take a look at what that particular veteran benefits they truly need. One thing I want to remind you about is that if you do sign up a veteran on a MAPD plan, and they have not had a part D in any form or fashion over the years, they will get a late enrollment penalty letter from that carrier that you sign them up with.
Even if you sign them up with a PDP plan or MAPD plan, let them know about the letter that's coming. And that letter will give them an option to say that they are a veteran and having VA coverage is credible coverage. They will be able to avoid that late enrollment penalty. They do have to respond to that letter, sign and date it March on there that they were that they are a veteran and that that late enrollment penalty will be waived.
Make sure you let your veterans know if you sign them up on the empty or PDP that the letter will be coming.
Tricare for Life beneficiaries
Another question that comes up quite a bit are Tricare for Life beneficiaries. As you know, Tricare for Life are people who are retired military. As you know, Tricare for Life is a wrap around. It wraps around your Medicare, so Medicare is your primary payer if you're on Tricare for Life and Tricare for Life will pay secondary. For years and years, I was always told never, ever sign up somebody that's on Tricare for Life. Well, for the same reasons that a general somebody who just has veteran benefits that they like the MA and MAPD plans that are very attractive because of their extra benefits, that's the same reason why your Tricare for Life people will look at these same types of plans.
Tricare for Life does come with credible drug coverage. I would suggest that you look at an MA only plan for those beneficiaries because they really don't need the additional prescription drug coverage and you don't want it to interfere with what they have with Tricare. If you look at an MA only plan, in a plan with no drug coverage, be sure that that particular plan meets the needs of your client. Do a full needs analysis to make sure this is the right plan for them.
Tricare for Life does come with credible drug coverage. I would suggest that you look at an MA only plan for those beneficiaries because they really don't need the additional prescription drug coverage and you don't want it to interfere with what they have with Tricare.
Tricare for Life will pay secondary, so whatever plan you put them on will be your primary coverage for that beneficiary. Tricare will pay secondary to to that plan. Again, all of the same things we talked about earlier, HMO versus PPO, make sure that the providers they want to use are part of that program says that will be the primary payer.
Veteran Benefits with ChampVA
Last but not least, ChampVA. This was something that had to do some research on, it's rare that I run into a ChampVA beneficiary, but we are seeing it more and more in the field. ChampVA is for a lot of times your spouses, widowers and children of qualified veterans, sponsors that are out there. ChampVA beneficiaries have some pretty rich benefits. It pays secondary to Medicare, so Medicare is primary and ChampVA pays secondary. But one thing that they have that's very unique is something called med's by mail and that meds by mail benefit is extremely rich. The benefit is pretty much no cost to those beneficiaries who fill their prescriptions through meds by mail.
Of course, that's going to be a lot of medications and maintenance drugs that they get quite frequently. So if you sign that client up on a PDP or an MAPD, they will lose that meds by mail. So, again, if you look at some but something I plan for a ChampVA member or a client, I would definitely lean more towards your MA only plans because you don't want to mess up that meds by mail benefit or their general veteran benefits. With VA paying secondary to Medicare, again, you want to make sure that primary coverage (your MA only plan) meets their needs. Is it is it the doctors and hospitals that they want to go to in order to utilize part of that program?
I would caution you to make sure that you don't mess up their meds by mail. And if you do put them on some type of PDP or MAPD plan, it will take them off of their meds by mail benefit. We don't want to hurt anybody, we want to help somebody. Most are very attracted to the extra benefits that come along with the MA only plans, the dental, the vision, the hearing, and everything that everybody else is attracted to as well. Again, I want to mention that ChampVA will pay secondary to whatever plan you put them on. Also right now, Medicare is primary for them and ChampVA is secondary.
I would caution you to make sure that you don't mess up their meds by mail. And if you do put them on some type of PDP or MAPD plan, it will take them off of their meds by mail benefit. We don't want to hurt anybody, we want to help somebody.
Even if they still had employer group coverage, the employer group coverage would be primary. Their Medicare plan would be secondary, and then ChampVA would be a third payer. I just always remember ChampVA is probably going to pay last on any type of coverage that they currently have.
A lot of people ask me, is this an SEP for people, so there is an SEP out for veterans who have VA benefits. If your veteran had a current MAPD or PDP, Tricare for Life, or ChampVA is considered other credible coverage, so that does create an SEP for those beneficiaries to be able to make a change throughout the year.
Make sure that you do your needs analysis just like any other client for your standard veterans, your Tricare for life and your ChampVA. From time to time, you might run into someone who never applied for their veteran benefits. It's pretty simple to help them apply for the VA benefits. If they get qualified that creates a special election because at that point they have other credible coverage as well. You can put them on the MA only or MAPD.
I hope this has helped. If you have any questions or concerns, please give us a call here at Tidewater at 888-622-9122. We'll be glad to help you. And I hope you have a happy sales.