Veterans

A U.S. Senate Committee on Veteran’s Affairs study shows almost 60% of veterans are Medicare eligible. Medicare Solutions, Inc. has made a special effort to help educate them about their options as Medicare beneficiaries. Many veterans had questions in 2006 about Medicare as a result of the government’s Medicare Part D program for prescription drugs. As a result we were invited to participate in a local television series about Veterans and Medicare-Questions and Answers.

Veterans who are also Medicare beneficiary’s (dual eligible) are in a unique position. They are entitled to their VA health care benefits because of their service in the military and they are also entitled to their Medicare health care benefits because they earned enough credits through their payroll taxes. The VA and Medicare benefits do not conflict in any way. Veterans have the luxury of deciding which one they wish to utilize without losing the other.

Many veterans are not properly informed about their Medicare rights and what programs they may be eligible for. Our Benefits Representatives are licensed and trained to help educate and assist veterans in this area. We call it a Medicare "check up". During these "check ups" we find many veterans are eligible for some of the following programs:

• Medicare Savings Program - The state will pay Medicare Beneficiary's Part B Premium ($104.90 per month in 2015).

• Medicare Part D Program - Government Subsidized Prescription Coverage that can save 50% - 75% on a veteran's prescription drug cost (If paying $8.00 per prescription at VA).

• Medicare Part C Program - Enhances Medicare coverage (reduces deductible and co-insurance) whether as a back up to VA or the veteran chooses to use Medicare covered health care system as primary.

Any veteran who is also a Medicare beneficiary and has Medicare Part A and Part B is eligible (unless they are diagnosed with End Stage Renal Disease) for Part C of Medicare-aka Medicare Advantage Plan. Many of these plans also include Part D (prescription drug coverage) and do not have an out of pocket premium beyond the Part B premium the beneficiary is already currently paying ($93.50 per month in 2007). All SNP (Special Need Plans) have no additional premium. Special Needs Plans are specifically designed for Medicare and Medicaid eligible individuals.

As of May, 2004 a CMS (Center for Medicare and Medicaid) study indicated that out of pocket costs for Medicare Advantage enrollees were 34% lower than for beneficiaries that have traditional Medicare coverage. An updated CMS analysis that was released in April of 2005 estimates that Medicare Advantage enrollees are expected to save approximately $100 per month or $1200 per year compared to original Medicare beneficiaries.

This option within the Medicare system enhances the Medicare coverage for veterans. Section 5 of the 2006 handbook, "Medicare and You" (Government handbook sent to all Medicare beneficiaries) best explains this option. "Medicare Advantage Plans (Part C of Medicare) are health plan options that are part of the Medicare program. If you wish to join one of these plans, you generally get all your medical covered health care through that plan. This coverage can include prescription drug coverage. Medicare pays a set amount of money for your health care every month to the private health plans, whether or not you use the services. In most of these plans, generally there are extra benefits and lower co-payments than in the original Medicare plan..."

Medicare benefits can become an important issue for Veterans. Examples of these include:

• Emergency Coverage - In the event of an emergency the best interest of the patient is to be taken to the closest hospital (ex. - heart attack) by an ambulance or other party. This applies also while traveling out of state or abroad. Statistics show 70% of Veterans that have heart attacks receive treatment at a Medicare covered hospital.

• Critical Care - Life threatening conditions can put a veteran in a position that Medicare covered health care may be an option (speciality cancer care, specific disease management, Cleveland Clinic, Etc...).

• Doctors Appointments - Some veterans prefer to see a Medicare covered family doctor because of the location of the office, time required for appointment, specialty care, etc....

• Prescription Formularies - The list of prescription medications (formulary) available through Medicare Part D plans are more extensive than the formulary available through the VA. The VA's formulary has about 1400 prescriptions, where most part D plans have about 4300 available. This expands the options for a physician to prescribe a more specialized drug to combat a specific condition which leads to a higher quality of care.

The Veteran's Administration sent a letter late in 2005 advising veterans that the VA's prescription drug coverage was considered "credible coverage". This means the VA's coverage, as an average, was considered to be at least as good as the Medicare prescription drug coverage. This provides a way not to be penalized if the VA changes or cancels their drug coverage in the future and a veteran wants to enroll in the Medicare Drug Plan at that time. There are situations where some Medicare Plans are more favorable than the VA's coverage. These include 0 co-pay for some generic drugs, $3.00 to $5.00 co-pays for name brand drugs (lower income qualified veterans) and a larger formulary of medications available.

Making informed health care decisions requires having all the facts. Medicare Solutions, Inc is committed to providing veterans with these tools. Our Benefits Representatives are licensed and trained to not just help evaluate and educate, but also assist with navigating the paperwork for the programs and benefits described above.