100% disabled vets, VA, Medicare Part B & Optum Community Care

[yorkriver1]

I am being asked if there is an issue with the vet dropping Part B part one.
Do any of you have experience with 100% disabled veterans who are VA enrolled, not retired military, therefore no Tricare, and their possible need for an MA only plan?
I have not worked with a 100% disabled vet to this point, and another person who wants to enroll the vet in an MA only plan is asking me, part two.
The vet says he is covered by Optum.
My research to date: Optum Community Care, a subset of Optum Serve, a UHC subsidiary, VA support/management service, is a network of community medical providers the VA can send vets to for treatment as needed. So in this case for us agents when a vet says they have Optum, they probably don't mean that's the PBM listed on a Medicare PDP/MAPD ID card. My first encounter, outside of Medicare products we sell, with the broad spectrum of UHC's Optum big data and medical care reach.

 

[Chazm]

I always tell my VA guys to call the VA and ask them if they should get part B. They are always told that they highly recommend them getting it. As agents we know why, obviously, but it hammers it home when they hear it from the VA.

I’m in FL and it’s an easy lay down for a part B refund plan with $130-148 back. I’m not sure of your area and I’m pretty sure you don’t do MAPD.

i guess I would ask him if he’s talked to Optum and asked what happens when he’s Medicare eligible.

 

[yorkriver1]

I always tell my VA guys to call the VA and ask them if they should get part B. They are always told that they highly recommend them getting it. As agents we know why, obviously, but it hammers it home when they hear it from the VA.

I’m in FL and it’s an easy lay down for a part B refund plan with $130-148 back. I’m not sure of your area and I’m pretty sure you don’t do MAPD.

i guess I would ask him if he’s talked to Optum and asked what happens when he’s Medicare eligible.

Good suggestions all around, thank you. There is an MA only plan the vet can get with $50 back on Part B in my state, best we can do here. Being 100% disabled, and supposedly having more hands on front of the line treatment, I wonder if someone there did tell him Part B was somewhat optional. We will see. Since dropping Part B is a pretty serious decision, it is best if they confirm that choice with the VA.

 

[DonP]

Most states $50 part B with great dental and $100 back with cleanings and fillings only .Ran into a guy during aep,100% va uses but slmb and no part b .he never wanted to pay for it . I said apply today as you’ll pay nothing and no penalty . He got part B which starts July 1 . I’ll write him a partial dual with $2 k dental and a $40 food card . He doesn’t need part b giveback .Plus he can go to outside drs at $0

 

[sunny1ib]

The VA encourages all veterans to enroll in Medicare Part B. Whether it is in plain language as that may be questionable. If you send a veteran back to his/her VSO (veteran service officer), a number of them may say the veteran does NOT need Medicare Part B.

There are different group levels of veteran statuses. Priority Group 1 consists of those veterans who receive 100% VA coverage and pay no costs relating to his/her care. The veterans are 100% service connected disabled. One cannot get any higher than that. Veterans with 50% service connected disability status can also be in this group and, depending on his/her financial situation may be subject to copays.

The lower Priority Group Levels of 7 & 8 are those veterans who don’t qualify for any of the Priority Group levels (1) 2-6. These veterans agree to pay cost shares for their VA coverage.

Veterans in any of the Priority Groups technically should have Medicare Part B, even those in Priority Group 1. The VA pays for service connected disabilities. There may be some gray area for a medical diagnosis that may not be causally related to the disability that qualified the veteran for Priority Group 1. Also, depending on how far away the veteran resides from the VA facility, it may be more convenient for the veteran to receive local care, hospitalization and procedures. Having the ability to enroll in a Med Supp or MA, or MAPD plan may be beneficial to the veteran.

Keep in mind that VA benefits is not qualifying coverage to enroll in Part B benefits if the veteran did not enroll when first eligible (hence he/she may be subject to Part B penalty). For Part D purposes, VA prescription drug benefits is considered qualifying coverage.

Part B giveback MA plans are popular for veterans as they get some of their money back. And, MA plans that have value added benefits like the food card, OTC quarterly stipends, basic gym membership and not to mention the ability to see more stable providers can be a huge plus.

 

[yorkriver1]

So the 100% disability vet priority 1 subject in question's best failsafe option if wanting the most healthcare backstop options, keep Part B and get a give back MA plan. Noting to the vet that if they drop out of Part B, it won't be pretty to try to get back in time and cost-wise. At this time, given the advice from the VSO to drop Part B, may be hard to overcome.

 

[sunny1ib]

Yes. However, not all veterans will want a MA, MAPD, or PDP plan. Some will want a Med Supp. Plan B is the basic to cover hospitalizations, but in my own BOB, I have veterans who have had lost one specialist after another, or in some cases s/he do not have the confidence in the provider. So those individuals will seek part of their care outside of the VA. A duplication of benefits? Not exactly. VA benefits and Medicare benefits do not reciprocate (except in a very rare and specific circumstance(s)).

Fact finding on how the veteran uses medical services should be conducted unless, of course, our happy SOA states otherwise.

 

[somarco]

Yes. However, not all veterans will want a MA, MAPD, or PDP plan. Some will want a Med Supp. Plan B is the basic to cover hospitalizations, but in my own BOB, I have veterans who have had lost one specialist after another, or in some cases s/he do not have the confidence in the provider. So those individuals will seek part of their care outside of the VA. A duplication of benefits? Not exactly. VA benefits and Medicare benefits do not reciprocate (except in a very rare and specific circumstance(s)).

Fact finding on how the veteran uses medical services should be conducted unless, of course, our happy SOA states otherwise.

All excellent points posted by you in this thread. Probably one of the more complete explanations I have seen on this forum regarding Veteran coverage & Medicare.

Too often agents take the quick route to analyzing client needs and go direct to the financial evaluation . . . completely overlooking a more important angle . . . access to care.

Saving $$ is of limited value when you cannot get the care you want or need because of plan restrictions.

Your early AM post is confusing when alluding to Plan B and hospitalizations. Perhaps Plan B is a reference to alternate care (backup plan) when VA facilities are not a good option?

Medicare PART B is outpatient care . . . which I am sure you know.

Again, thanks for sharing your knowledge.

 

[sunny1ib]

All excellent points posted by you in this thread. Probably one of the more complete explanations I have seen on this forum regarding Veteran coverage & Medicare.

Too often agents take the quick route to analyzing client needs and go direct to the financial evaluation . . . completely overlooking a more important angle . . . access to care.

Saving $$ is of limited value when you cannot get the care you want or need because of plan restrictions.

Your early AM post is confusing when alluding to Plan B and hospitalizations. Perhaps Plan B is a reference to alternate care (backup plan) when VA facilities are not a good option?

Medicare PART B is outpatient care . . . which I am sure you know.

Again, thanks for sharing your knowledge.

 

[sunny1ib]

Thanks for the kind words Somarco.

After I posted my response, I thought I may confuse folks regarding Medicare Part B vs. Medicare Supplement Plan B. Veterans and some other individuals on certain types of government plans may benefit from Part A. I personally have found that veterans will find more comprehensive supplemental benefits that are less expensive if they are looking to augment their VA benefits. If they are taking the either or method, then the supplemental offering from Plan C - Plan N should be considered.

What to I mean by "augmenting their VA benefits?" Depending on the Priority Group, some veterans, may (note the term may) be able to go back to the VA and use a VA facility or qualify for a VA approved facility. This facility has to be approved by the veteran's primary care physician, which means that the veteran may use his/her Medicare for specialty services, but uses primary care services thru the VA. It doesn't have to be this way, but it can be this way depending on how far the veteran lives from VA medical service facility. The VA does have outreach medical posts available (aka clinic), and these clinics are extremely busy. There is now, where in previous years there was not, electronic record sharing for those veterans who choose to use private specialists due to proximity, scheduling delays, and/or limited or no specialists available for the veteran at the VA hospital. In the event you are working with a veteran who is not aware of this, he/she should be enrolled in My HealtheVet and have Premium status. Enrollment in My HealtheVet can be done online in the comfort of their own home. In order to enroll in Premium status, this takes a form with a wet signature to be turned in. Electronic record sharing can be done with outside providers at that point (I am not certain if this (electronic record sharing) has been rolled out to all VA hospitals, I do know they are in most of the rural states).

Medigap Benefits
Plan A Plan B
Part A coins & Yes Yes
(2022 cost $389
for 61-90 days)
hospital costs up to
(2022 - $778 lifetime
reserve days an add'l
365 days after Medicare
benefits are used up
Part B coins or copay Yes Yes
Blood (first 3 pints) Yes Yes
Part A hospice care
coins or copay Yes Yes
Skilled nursing facility No* No*
care coinsurance
(2022 - $194.50 per day
from days 21-100)
Part A deductible** No Yes
2022 $1,566
Part B deductible No No
Part B excess charge No No

The difference in Medicare Supplement Plan A and Medicare Supplement Plan B is ONE base, but costly benefit - Plan B covers the Medicare Part A Deductible. We all know that the Part A deductible is a pretty hefty amount. This is why I suggest to my clients Plan B.

Some may ask about the Skilled Nursing Facility care coinsurance. Here is where we as their agent/broker can do our magic and explain the merits of MA plans and a Medicare Supplement Plan C - N (whichever one makes financial, accessible care - basically reasonable sense to the client) because who really wants to part with $15,365.50 if his/her stay was to the maximum 100 days in the SNF? This would make any Priority Group uncomfortable, but particularly Priority Groups 7 & 8 where they are not receiving much in the way of VA benefits at all.

I hope this clears up any confusion Somarco. And again, thanks for the kind words.