Includes PPO, HMO, HMO-POS medical plans with or without drugs.
Do you have health coverage through the Department of Veterans Affairs (VA)? Or maybe you are covered through TRICARE? Or do you get health coverage as the spouse of a veteran through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)? If you do, you may not think a Medicare Advantage (MA) plan has anything to offer that you don’t already have.
But an MA plan may actually provide added benefits to help you achieve your health goals. The key is choosing a plan that complements your current benefits. That way you’ll get the support you need to help you make the best choices for your health.
“The key is choosing a plan that complements your current benefits. That way you’ll get the support you need to help you make the best choices for your health.”
The importance of creditable prescription drug coverage
Before you learn about how an MA plan can give you more, you need to know a bit about creditable prescription drug coverage.
It’s any drug coverage the federal government considers to be at least as good as the coverage provided by Medicare Part D. That’s the part of Medicare that provides prescription drug benefits.
Why is creditable prescription drug coverage a big deal for some people? Because if someone goes without it, they may end up paying a penalty if they delay their enrollment in Medicare Part D. Fortunately, creditable prescription drug coverage could include drug coverage through the VA, CHAMPVA and TRICARE. So if you continuously have these benefits from the time you qualify for Medicare benefits, you may not be charged a penalty regardless of when you choose to sign up for Medicare benefits. But if you aren’t sure if you have creditable coverage, you should check with your coverage provider.
A quick guide to creditable prescription drug coverage
What is creditable prescription drug coverage?
Prescription drug coverage that provides benefits at least as good as the standard Medicare prescription drug coverage.
Why is it important?
If you don’t have creditable coverage, you may have to pay a penalty if you don’t enroll in Medicare prescription drug coverage when you’re first eligible.
How do I know if I have creditable coverage?
Your coverage provider must notify you each year prior to October 15 if you do or do not have creditable coverage.
At this point you may be asking yourself, “If my current prescription drug coverage is as good or better than Medicare Part D, what benefits can an MA plan offer that I don’t already have?”
Read on to find out.
The freedom to choose from more health care providers
Since you already have prescription drug coverage, an MA plan without drug coverage — often referred to as an MA-only plan — is a potential option for you. They are called MA-only plans to help distinguish them from Medicare Advantage plans that include prescription drug coverage. Those are often referred to as MAPD plans.
MA-only plans provide greater freedom when it comes to getting health care. For example, if you get your care through the VA Medical System, TRICARE or CHAMPVA, but you prefer to see a non-VA doctor for certain types of care, many MA-only plans may cover those visits. Or perhaps you just want a second opinion about a diagnosis or treatment plan provided by a doctor at the VA. You may also be able to use your MA-only coverage to get an opinion from a physician who is not part of the VA health system.
If you want to use your MA-only coverage to see a variety of non-VA health care providers, you might consider the health maintenance organization (HMO) or preferred provider organization (PPO) MA-only plans available to you. An HMO plan generally only covers you when you see providers within your plan’s network, and specialist visits usually require a referral from your primary doctor. With a PPO plan, you can visit Medicare-approved providers in or out of your plan’s network who accept your plan’s terms. But you’ll likely pay more for services from providers outside your network.
Whether you choose an HMO or PPO, it’s always important to make sure the providers you may want to see are part of your plan.
Extra benefits through Medicare Advantage
The extra benefits go well beyond second opinions or the ability to choose a non-VA provider. MA-only plans can also include a host of benefits that are not part of standard VA coverage. For example, many veterans don’t qualify to receive dental care from the VA, but MA-only plans often provide dental benefits.
MA-only plans may also offer benefits outside the clinic or hospital setting that can help you reach your health goals, such as gym memberships. And some plans can even help pay for vitamins, supplements and other over-the-counter remedies. Select MA-only plans even deliver meals to your home when you’re recovering after a hospital stay. All these extra benefits can help, and they won’t replace your existing benefits to keep you leading your best life.
Manageable costs
What are some of the extra benefits you can get with an MA-only plan?
Benefits vary by plan, but covered services may include:
Dental benefits like cleanings, X-rays and fillings
Vision benefits like glasses and contact lenses
Hearing benefits like hearing aids
An allowance for over-the-counter items like vitamins
Fitness benefits like gym memberships
Perhaps the best part is there are many MA-only options with predictable costs. Plans often have low or $0 premiums. And many offer modest copays or coinsurance for a wide array of medical items and services. They also come with an out-of-pocket maximum, which means you will never be charged more than a predetermined amount per year for covered medical services as part of your plan. The out-of-pocket maximum can serve as a financial backstop if you’re ever confronted with large out-of-pocket expenses due to an unexpected medical event that is not covered by the VA or TRICARE.
Given their predictability, their added benefits and the freedom they provide, MA-only plans can help play an important role in maintaining your whole health, even if you have coverage from another source. While your existing benefits may give you most of what you need, an MA-only plan could be the final piece in your coverage puzzle.
About the author
Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far-flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.
