Can veterans have Medicare Advantage plans with VA benefits?

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 edition of “Medicare for the Record.” Thank you so much for joining us. You know, there are a lot of different elements to Medicare and Medicare Advantage plans—and for one particular group, it might seem even more complex. And that group, Patrice, is veterans.

Patrice King Brown: That's right, Stacy. And it can be confusing for many. Many veterans who become eligible for Medicare wonder how their veterans benefits work alongside Medicare coverage. Questions about the VA and Medicare Advantage plans, prescription drug coverage and provider access—all very common, sometimes very confusing.

In this episode of “Medicare for the Record,” we'll discuss how Medicare works for veterans, what coverage options are available, and why some veterans choose to enroll in Medicare Advantage plans even if they already receive VA health benefits.

Stacy Smith: With us to talk about this is UPMC for Life Benefits Advisor Joe Lepez. Joe is a 10-year Air Force veteran who was stationed in Europe, Panama, and Florida, and deployed to the Middle East. Joe has been with UPMC for more than 10 years and a licensed Medicare advisor for the past five years. Joe, thanks so much for joining us.

Joe Lepez: Thank you so much for having me.

Stacy Smith: And let's just jump right into it. How does Medicare work for military veterans?

Joe Lepez: Excellent question, Stacy. So a lot of folks that are veterans, when they get to be Medicare age, they don't think that they need Medicare. And so they might miss out on getting an opportunity to get coverage that might be outside of the VA. Now, folks that have the Veterans Administration Health System and Medicare are two separate programs, but they can work alongside each other. As a matter of fact, by getting Medicare, that opens the door for you to be able to see providers that are non-VA providers. For example, if you’d like to be seen by your local primary care doctor, that would require Medicare.

Stacy Smith: Right. So you're on VA benefits, but there are other veteran benefits as well, such as TRICARE and CHAMPVA. What are those?

Joe Lepez: That's right, Stacy. So there's Veterans Affairs benefits. Those are for veterans in general that usually qualify due to a disability. Then you have TRICARE For Life. Those are for retired veterans. And CHAMPVA, those are for qualified dependents, dependents of veterans that qualify for that particular program.

Patrice King Brown: So then since those programs are in place, why would they need a Medicare Advantage plan?

Joe Lepez: Excellent question, Patrice. So the reason why that would be the case, as I said before, it's to enable them to be able to have access to healthcare that otherwise they wouldn't. And in the case of the TRICARE For Life and CHAMPVA folks, it gives them additional benefits and a plan that would work in conjunction with as Medicare does.

Patrice King Brown: So veterans can have both VA health benefits and Medicare Advantage coverage at the same time?

Joe Lepez: That's right, Patrice. As a matter of fact, for certain coverage like TRICARE For Life and CHAMPVA, a veteran and/or a qualified dependent must have Medicare Part A and B.

Stacy Smith: Joe, on CHAMPVA, this really has to do, as you mentioned, it has to do with spouses?

Joe Lepez: Yes, sir. Correct. Qualified dependents, including spouses—that is the program that is put together by Department of Veterans Affairs for them. It's called CHAMPVA. It's the equivalent of TRICARE For Life for qualified veterans.

Stacy Smith: And the Medicare Advantage plan can work for them as well?

Joe Lepez: Yes, sir. The same as it would for a TRICARE For Life eligible member.

Stacy Smith: All right. I'll ask you this question then, Joe. If someone's with VA now, and they use the Medicare Advantage plan, can they still use their VA doctors?

Joe Lepez: Absolutely. As a matter of fact, the VA benefits do not go away. This is in addition to what they already have.

Patrice King Brown: And there's a lot involved in that, Joe, in deciding what plans and what should they do. What kinds of benefits should they be looking for?

Joe Lepez: So one of the reasons why veterans choose, other than access to additional healthcare is because of what I call the “goodies.” The benefits like vision, dental, hearing, free gym membership, a card, an allowance that allows them to buy over-the-counter products. All of these benefits, they do not come with a veteran's healthcare, nor do they come with Original Medicare. So this is something that many veterans look forward to when they find out that they're eligible for.

Patrice King Brown: Oh, I'm sure. So Joe, are there Medicare Advantage plans just developed for veterans?

Joe Lepez: Yes, Patrice. I'm proud to tell you that UPMC for Life has a plan called the PPO Salute that is specific to veterans that have TRICARE For Life and/or qualified dependents that have CHAMPVA. And this plan was put together by a veteran on our team who is very much involved in the community. As a matter of fact, I think you folks know him. You interviewed him last year. His name is Chris. This plan, the PPO Salute, it's what we call a wraparound program. What it does—it basically mimics or closely follows what Medicare Part A and B does for a veteran and provides additional benefits, including a substantial Part B buyback that they will see. And also provides, as I said, these other benefits that I call “goodies,” like vision, dental, hearing, free gym membership, and that allowance for over-the-counter products.

Stacy Smith: OK, Joe, what is a Part B buyback?

Joe Lepez: I'm glad you asked, Stacy. So the Part B buyback, it's actually a monthly reduction of the Part B premium. Every person that has Medicare usually would have to pay a Part B premium. What this buyback does—it reduces the amount that you're paying, and you'll see that increase in your Social Security check. Or if you're not collecting, you'll see it in a reduction in your Social Security bill that you receive for your Part B premium.

Stacy Smith: This sounds kind of confusing, but it's really not any more confusing or an obstacle for people to use than regular Medicare Advantage plans.

Joe Lepez: Correct. So nothing as far as how things work change. The PPO Salute, as I said, mimics what Medicare already does. So a veteran that has TRICARE For Life doesn't see a whole lot of difference other than getting these extra benefits. The PPO Salute works all over the 50 states, all over our country. And any doctor that accepts Medicare will accept this plan and it works as the primary payer.

So it would pay first, 80 percent. Then TRICARE For Life or CHAMPVA would be the secondary payer. It would pay the 20 percent remaining. So usually all services are covered at 100 percent for veterans that are eligible for the TRICARE For Life/PPO Salute combination.

Give you a specific example: Outpatient surgery, which is sad to say as we age, more likely to happen, right? Whether it's knee replacement or cataract surgery. This is something, just to make it easier on us for math wise, let's say it's a $1,000 claim that's submitted to PPO Salute, to UPMC for Life. We would pay $800 of that claim. The remaining 200—that 20 percent—is paid for by TRICARE For Life. End result: no bill for the veteran.

Stacy Smith: So there's a primary payer, which is UPMC for Life, and then the secondary payer is your TRICARE?

Joe Lepez: That's correct.

Stacy Smith: OK.

Joe Lepez: And for those veterans that haven't retired from the military, then we have—like myself, I didn't retire from the military, but I would have access to the VA and I could get prescription drugs from the VA. We have the HMO No Rx plan. The HMO No Rx plan is a plan that's specifically tailored for folks that have access for prescription drugs through alternative means. Like I said, the VA, or some folks that had nothing to do with the military that have access to PACE or PACENet. This is a program that the state puts together for our seniors to help them with the cost of their prescriptions. Great program, by the way. They can also use the HMO No Rx.

What the HMO No Rx does, it provides additional access to coverage outside of the VA. Plus it also provides vision, dental, hearing, and also free gym membership. And even the best part, in my opinion, is the generous Part B buyback that I already discussed before as well, just like the PPO Salute.

Patrice King Brown: There are lots of goodies people need to be aware of. We like the goodies.

Joe Lepez: Yes, I like the goodies too.

Patrice King Brown: And for the veterans who have served, they deserve them. So that's good to know. You hate to have people not getting the things that they actually have available to them.

Joe, what advice would you give to veterans who are planning to review their Medicare coverage for 2027?

Joe Lepez: So the advice I would give veterans would be the advice I give to every person that is becoming eligible for Medicare. It's a big milestone. And so there's things to consider. For example, one, what are your healthcare needs? How are you feeling at the time? And also though, not just at the time, but also projecting in the future. What benefits are you not getting that you might be eligible for? That's the whole reason why we look at Medicare Advantage plans, even though maybe we have everything covered under TRICARE For Life, to get those additional benefits. Also, the possibility to get some money back on your Social Security check. I think that's very important.

So all these extra points that are available to you, that's when you make your decision. And the easiest way to get all this handled is just simply talking to one of us Medicare advisors, like Yours Truly here. I enjoy having these conversations, helping folks get the best Medicare coverage that they can get.

Stacy Smith: Joe, thank you so much for being with us.

Joe Lepez: Thank you. Appreciate it.

Stacy Smith: A couple of things we'd like you to remember about today's conversation. And that is a Medicare Advantage plan can be an option for someone with coverage from the VA, TRICARE For Life, or for CHAMPVA. And you can get extra benefits by adding a Medicare Advantage plan to your coverage, and it doesn't take anything away. So compare your options based on your coverage and health needs.

Patrice King Brown: For more information, you can visit medicare.gov, cms.gov, or the UPMC for Life website, which is upmchealthplan.com/medicare.

Again, Joe, thank you for your service and thank you for your time today. We appreciate it. And we thank you for joining us and look forward to having you on our next episode of “Medicare for the Record.”

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 healthcare 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.