How Medicare Advantage plans provide extra support for veterans

Patrice King Brown: Whether you’re new to Medicare, exploring your options, or just want to keep up with the latest in Medicare news, we’ve got you covered.

Stacy Smith: No fluff, no jargon. Just real conversations to help you navigate Medicare with confidence. I’m Stacy Smith.

Patrice King Brown: And I’m Patrice King Brown. Welcome to “Medicare for the Record,” brought to you by UPMC for Life.

Stacy Smith: Welcome to this episode of “Medicare for the Record.” And if you're a veteran, I think you're going to find this program very interesting. We have a very special guest with us today, and that is Chris Preffer. He is the director of program innovation and improvement for Medicare at UPMC Health Plan. And Chris is here to explain how Medicare Advantage plans can work with VA coverage or TRICARE to offer members more benefits and reduce out-of-pocket expenses. Chris, thanks so much for joining us. Before we begin, you are a veteran yourself.

Chris Preffer: I am, I am. I served 22 years in the Air Force stationed right here in Pittsburgh. Had a great time doing it. Got to travel all over the world. Today I do have access to the VA and I have TRICARE as well. And so my experience in both of those actually is what helps me design the Medicare Advantage plans for the veterans who do have those benefits.

Stacy Smith: Excuse me just for a second, Patrice, I'm sorry, but you mentioned TRICARE.

Patrice King Brown: That's what I was going to say…

Stacy Smith: OK, we both had the same question. What is TRICARE?

Chris Preffer: TRICARE is a health insurance for veterans, so those who are currently serving and their dependents, but it's also a benefit that those who have served 20 or more years and retired from the military get as part of their retirement package.

Patrice King Brown: OK. Well, OK, the question is how do Medicare Advantage plans work with VA benefits, TRICARE, and also something called CHAMPVA?

Chris Preffer: Yeah, so Medicare Advantage plans work with all those. They work alongside them. If it's Tricare or CHAMPVA, both of those are health insurance, right? So we talked about what TRICARE is. CHAMPVA’s actually health insurance that's provided by the VA, not for the veteran but for the dependents of veterans. So if the veteran is a hundred percent disabled or passed away from a service, disabled service-connected disability, then their dependents could have CHAMPVA. And so that's again a health insurance that people would use outside of the VA.

The way those two work with a Medicare Advantage plan is that they will pay what Original Medicare passes to the member. So Original Medicare for most things, they'll cover 80 percent and the member has to pay 20. Well, TRICARE will pay that 20 percent in most cases.

Patrice King Brown: Isn't everybody, same thing for CHAMPVA, I assume for the family members?

Chris Preffer: That's right.

Patrice King Brown: But isn't everybody who has served just able to have VA services?

Chris Preffer: So they're not. They’re not. So though we all started our veteran journey, our military journey in the same space at basic training, we all finished that journey in a much different place. And so access to the VA is much the same in the way that if you have a service-connected disability, so you lost your hearing or it's degraded from your military service, or a big one that we saw with our Vietnam veterans is working around Agent Orange and years later they had cancers that were linked back to Agent Orange. Those are service-connected disabilities. And because of those you could have access to the VA. Or if you served in a combat zone or there's a number of other ways that you could have access to the VA from your service. However, not a hundred percent of people who serve have access to VA facilities or care.

Patrice King Brown: So it makes sense to have a Medicare Advantage plan.

Chris Preffer: It absolutely does. So even those of us that do have access to the VA—like I can access the VA for a number of things, but I don't have any issues with my mouth for dental services, so I can't be seen at the VA for dental. That's where a Medicare Advantage plan can actually help a lot of veterans is by providing those coverages for the gaps that the VA may leave for the veteran.

Stacy Smith: So they're covering the gaps. So that's one of the advantages of having a Medicare Advantage plan along with the VA benefits. Are there some risks, though, that are involved?

Chris Preffer: Yeah, so if you have just VA, right? We'll put TRICARE and CHAMPVA to the side for a second. So we're talking about those who just have VA access. When you're shopping for a Medicare Advantage plan, it's important to shop for one that'll complement your VA coverage. So one that's going to fill those gaps that's left by the VA. A lot of Medicare Advantage plans will offer gym memberships, those dental coverages like I mentioned, or vision or hearing services, even transportation to go get different things. And so if you have VA only, that's really what you're shopping for with a Medicare Advantage plan. And for everyone who has to have Medicare and pay their part B premium, a lot of Medicare Advantage plans that are marketed towards veterans will offer a part B give back, meaning you can pay less for your part B premium every month, which really just puts money back into the veteran's pocket.

Stacy Smith: But now the risk part.

Chris Preffer: Yeah, now let's go to the risk part. So the risk is, let's talk for those who have TRICARE, CHAMPVA. If you have TRICARE, TRICARE is only going to pay the cost shares that original Medicare passes to the member. So let's go through some scenarios, right? Let's say you go to a specialist visit. If you have Original Medicare, you're paying 20 percent of whatever that specialist visit is. TRICARE is going to pay that 20 percent.

Stacy Smith: So there's not out-of-pocket for you on that one, then?

Chris Preffer: There's not, as long as you're with Original Medicare, they're going to pay 80, right? TRICARE will pay the 20. So no concerns. So in this scenario, we'll say that the bill's $100, just to keep the math simple. If you go to a Medicare Advantage plan and say that specialist copay’s $30, TRICARE is still only going to pay 20 percent or $20 of the $100 bill, meaning the member is now responsible for that $10 copay that was left over. That’s a risk.

Stacy Smith: All right, that's a doctor, a specialist you might go to. What about other things that we always have to have done, lab work, that sort of thing?

Chris Preffer: Yeah, so lab work is covered 100 percent by Original Medicare, meaning TRICARE pays absolutely nothing. There's Medicare Advantage plans out there that will have a 20, 30, or even a co-insurance amount of like 30 percent of whatever the lab cost was, right? That member is going to pay 100 percent of whatever that cost is. TRICARE is not going to cover it at all.

Stacy Smith: OK. Something none of us want to look forward to, but staying in a hospital for a while.

Chris Preffer: Yeah, inpatient hospital stay. So right now, Original Medicare, it's a $1,674 deductible for the first 60 days that you go inpatient. TRICARE covers that. They cover $1,674. There's a Medicare Advantage plan out there right now that's marketed towards veterans that is $495 a day for the first six days. So if you take six times $495, you're looking at like $2,900 something. Remember, TRICARE is only going to pay $1,674, which means the remainder of that at $1,400, $1,300—that goes to the member.

Stacy Smith: Well then it doesn't sound like you'd want to have a Medicare Advantage plan. There has to be another reason to have one then.

Chris Preffer: So if you have TRICARE or you have CHAMPVA that are paying those cost shares that Original Medicare passes to the member, you need one that mirrors Original Medicare, which is why at UPMC, we developed the UPMC for Life PPO Salute product. It always mirrors Original Medicare so that those who have TRICARE don't have to worry about that out-of-pocket cost or that risk.

Stacy Smith: And these [Medicare] Advantage plans you're talking about then also come with some other benefits then?

Chris Preffer: Absolutely. So because we took all that risk out as well, we're still able to add a Part B give-back on the Salute product. We provide the dental, the vision, the hearing benefits, the gym memberships also a flex card. The Flex Spend Card covers medical copays, dental, vision, hearing, special fitness centers, over-the-counter items, and home safety devices.

Patrice King Brown: This is great. There's so much information and so many questions because I think most people just assumed if you were a veteran, that's the way you went and that was that's how you would have your medical care.

Chris Preffer: Absolutely. And one of the biggest misconceptions is that TRICARE will pay whatever I get as my bill. So if I go to a Medicare Advantage plan, whatever the bill is left over or my copays, TRICARE is going to cover that. We just showed examples of why that's not the case…

Patrice King Brown: …Not necessarily…

Chris Preffer: …And that's the biggest risk for someone who has TRICARE or CHAMPVA of when shopping for a Medicare Advantage plan, go with one that mirrors Original Medicare, otherwise you're at risk to pay out-of-pocket.

Patrice King Brown: So Chris, is there a specific enrollment period or a special eligibility criteria for veterans to enroll in a special program? I love the name of the program. It's the Medicare Advantage Plan, it's UPMC for Life PPO Salute. I like that.

Chris Preffer: Yeah. So there's really not a special election period just for veterans. It's really anyone that's Medicare eligible. Their annual enrollment period is happening actually right now. It starts every year on Oct. 15 and goes until Dec. 7. So there are a number of special election periods that everyone's eligible for throughout the year. And those are different based on plan and a number of other things. But for veterans and others who are Medicare eligible, it's really that annual enrollment period of whenever you can make your election changes.

Stacy Smith: We've been talking about being cautious about going into one of these Medicare Advantage plans if you have TRICARE and CHAMPVA, this sort of thing. What if you do that and you decide, this really isn't for me, using the VA benefits? Can you go back to Medicare?   

Chris Preffer: Absolutely. So anyone in a Medicare Advantage plan can always go back to Original Medicare. They can make that election during the annual enrollment period, again happening now. And they could also do it during an open enrollment period, which is from January to March every year as well. You can make that election if you were in a Medicare Advantage plan to go back to Original Medicare.

Stacy Smith: We were talking earlier and a lot of times a veteran may have served his or her country and nothing shows up, but later in life something shows up. So are these plans available at that time as well, or do you have to be diagnosed with something—I'm using the word diagnosed—with something as soon as you leave service?

Chris Preffer: Yeah. So if we're talking about can I have access to the VA, that is something that you're going to work out with the VA. And as we mentioned earlier about Agent Orange and the cancers and issues linked to that really don't happen until later on in life. So as you work through getting access to the VA, that's going to happen based on their timelines. As far as being eligible to come to one of our products or any Medicare Advantage product, it's really are you Medicare eligible? For most of us, that's going to happen when we turn 65 and age into Medicare. But for a number of others it's really based on the chronic conditions that now, regardless of your age, make you eligible for Medicare, right. So I even have a scenario where we had a retired veteran who had TRICARE and his wife had TRICARE, and both of them were Medicare age and on Medicare, but they also had a son who had a certain chronic condition, and though their son was in his thirties, he was now Medicare eligible. And because of that chronic condition, the parents still had him as a dependent, so he was eligible for TRICARE and Medicare. So all three of them came to our PPO Salute product because they had TRICARE.

Patrice King Brown: Well, you wonder what advice you might give a veteran at this point, Chris, who's looking into what do I need to do? I'm hesitant to enroll in a Medicare Advantage plan because they're not sure how it will affect their benefits from the VA or their TRICARE coverage. What do you say to them?

Chris Preffer: Yeah, so here's what I would say to them is that—a couple things: One, Medicare Advantage is supposed to work alongside your TRICARE or Champ VA benefits. We talked about those risks. So make sure that you're working with a licensed professional who can help you navigate what those risks are and find the right plan that works best for you. For those who have access to the VA, you know, it's really what do I get from the VA and what don't I get? Shopping for a Medicare Advantage plan should help fill those gaps that you don't get covered at the VA, and that would be my recommendation there. Right now, the VA does not bill Medicare. They're not allowed. So your VA benefits and your Medicare Advantage benefits are completely separate.

Stacy Smith: So Chris, if you go to the VA, who's going to pay: TRICARE, Medicare Advantage, Veterans benefit? Who's going to pay the bills?

Chris Preffer: Let's unpack that a little bit better in the way that if you're seen at the VA facilities, there's not a bill that's coming to TRICARE or Medicare today, right? So if you're seen at the VA, your copayment, should you have one, is going to be based on the services received and really your disability rating. For most things that you're seen for at the VA, it's really based on your service-connected disability. So you should not have a copay for it. But let's say you did and you still have TRICARE. TRICARE is never going to pay for something that was received at the VA because both are government funded. And so today, if you do have a copay with the VA and you do have TRICARE, TRICARE is not going to pay it. That's on the member.

Patrice King Brown: So then there still is a benefit to veterans having a Medicare Advantage plan.

Chris Preffer: There is. And so if you are one of those veterans that has access to the VA and you do have a copay for something on our PPO Salute product or HMO No RX product, those flex cards actually authorize payments for medical services. So let's say you do have a $20, $30 copay at the VA for whatever service, you could use that flex card to cover that. So it's still not money out of your pocket. Again, protecting the veteran and helping bridge those gaps that are caused by the VA or with TRICARE.

Patrice King Brown: It's a lot to think about, Chris.

Chris Preffer: It's a lot.

Patrice King Brown: It's a lot, but it is—it's important. I still was just surprised that everybody who is a veteran isn't covered, and I think many other people would be. So this is really good information to know, and for many it's new information.

Chris Preffer: Yes.

Patrice King Brown: We want to thank you so much for joining us today.

Chris Preffer: I'm so glad to be here. Thank you for this. Thanks for letting me talk about a subject that's near and dear to my heart and something that I truly believe in.

Patrice King Brown: Thank you.

Stacy Smith: Well, a couple of things we want you to take away from this conversation, great conversation with Chris, and that is, first, that a Medicare Advantage plan can enhance and complement the benefits you already have, not necessarily replace them.

Patrice King Brown: And secondly, if you do have TRICARE or CHAMPVA, it's important to choose a plan that mirrors Original Medicare, such as UPMC for Life PPO Salute, as this is the safest way to avoid unexpected bills.

Stacy Smith: And third and very important is don't be afraid to ask questions and talk to a licensed advisor who can understand veteran coverage. It is the best way to get a plan that works perfectly for you and your family. And Chris, before we go, one more question for you. And that is, how can people get more information?

Chris Preffer: So people can get more information at our upmchealthplan.com/medicare website or by calling our 800 number here at UPMC and those licensed advisors, if they're not sure what the answer is, they know how to contact me and I will help them find the answer.

Patrice King Brown: Good to know. Thank you. And thank you for joining us today for another episode of “Medicare for the Record.” We hope you'll join us next time.

Thanks for tuning in to “Medicare for the Record,” brought to you by UPMC for Life. To learn more about your Medicare options, visit upmchealthplan.com/fortherecord.

This podcast is provided for general informational and educational purposes only. It is not medical care or advice. For questions regarding medical care, please consult with your health care provider. Views and opinions expressed by the participants are solely their own and do not necessarily reflect those of UPMC Health Plan, its subsidiaries, parents, or affiliates.

 

UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.

 

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