This week, we observed Veterans’ Day, honoring Veterans for their incredible strength, resilience, and commitment to our country. As we are also in the midst of Medicare Open Enrollment (October 15 – December 7), now is an important time to ensure that our nation’s veterans are receiving the healthcare they require, whether it be from the Department of Veterans Affairs (VA), Medicare, or Medicare Advantage.
Recently, something troublesome has come to light regarding our veterans and Medicare Advantage plans — our tax dollars are being misused for services that were never rendered. Currently, almost 42 percent of all Medicare-eligible veterans have a Medicare Advantage plan. However, according to a new study, almost one in five of these veterans has received no Medicare services from their plan, as the services overlap with their VA coverage. Yet, the Medicare Advantage health plans are still receiving payments from the federal government, equating to Medicare Advantage plans receiving as much as $1.3 billion in excess funding for veterans who receive nearly no care through Medicare.
New Study Confirms that the Federal Government May be Paying Twice for Veterans’ Care
In the recent study conducted by scientists from the Harvard School of Public Health, Boston School of Public Health, and the VA, published in Health Affairs, it was found that the federal government may be overpaying for veterans’ health care through programs such as Medicare Advantage.
The study centered on veterans’ usage of Medicare Advantage. Since about 9 million American veterans are also covered by VA Health Care, researchers sought to determine how much excess federal funding was going to Medicare Advantage to serve veterans already covered by VA Health Care. These are some of the findings:
- Between 2016 and 2022, the number of veterans who enrolled in MA plans increased, and there was a significant rise in people joining “high-veteran MA plans,” or MA plans in which enrollment of VHA enrollees exceeds 20 percent of total enrollment in a given year.
- About one in five veterans who were in a high-veteran MA plan didn’t use any MA services in a given year. Veterans in MA plans were all-around more likely to get care from the VA than Medicare.
- In 2020, CMS paid more than $1.32 billion to MA plans for enrolling VA Health Care enrollees who did not utilize MA services — almost a 60% increase from 2016. MA plans receive full capitated payments regardless of whether or not veterans use Medicare services.
- The federal government incurred substantial duplicative spending.
- Medicare overpaid these health plans for care that they didn’t provide.
- The VA paid for the same care that Medicare Advantage could have covered.
- The VA was potentially being overcharged for care that the veterans could otherwise receive under their Medicare Advantage health plan coverage, or even Original Medicare.
- Researchers also reported on health plans being heavily marketed towards specific demographic groups, including veterans who don’t necessarily need these plans.
- Under names like “Patriot Plan,” “Courage MA,” and “Honor” plan, all of the major private Medicare insurers are courting veterans directly, selling plans that their ads say complement their Veterans Affairs coverage with benefits such as dental and vision. Read more about MA marketing practices in my recent article on the subject.
- However, with both MA and VA Health Care, veterans have the ability to access multiple health care systems and make a choice about which one is the right one for them given their location and their health needs.
- Some veterans are eligible for VA health care, but may choose not to use that system. There are also many people who wish they had access to VA health care, but don’t meet the restrictive eligibility criteria. As mentioned earlier though, most veterans opt to get care through the VA.
- The consensus is that the VA, CMS, and Medicare Advantage providers should work collaboratively. Congressional authority may be required to change some of the regulations and statutes that guide the way Medicare Advantage plans are being paid — especially for veterans that may not be receiving any care.
“As veterans navigate the increasing complexities of healthcare options, our research aims to inform policymakers and stakeholders about the urgent need to optimize the use of federal resources in veteran care,” Jose Figueroa, MD, an associate professor of health policy and management at the Harvard T.H. Chan School of Public Health, said in a statement. “This is particularly important given the substantial budget constraints that the Veterans Affairs system is currently facing.”
Military Veterans: Here’s What You Need to Consider About Medicare
Veterans who have the option to select a Medicare Advantage plan to complement their VA benefits should consider some key factors as they research plan options.
While a Medicare Advantage plan may help reduce gaps in your healthcare coverage and provide access to additional services and benefits that may not be covered by VA health care, it’s important to look at what Medicare itself covers and what your VA benefits cover. You may be paying for something you won’t use if you decide to go with a Medicare Advantage Plan.
As you research health plan options, it’s important to use credible sources such as Medicare.gov to compare plans and estimate costs based on your needs. If you’re unsure about some of the information you received from a Medicare Advantage sales person, you can call 1-800-MEDICARE for more assistance, or work with an experienced and independent health insurance agent who sells both Medicare Advantage plans and Medicare Supplement plans, which are very different. An experienced and independent health insurance agent can explain to you the differences between Original Medicare combined with a Medicare Supplement policy (sometimes called a Medigap policy) and any MA plans that you might be looking at.
Find the Medicare Plan that is Right for You and Plan Ahead for Your Family
At the Farr Law Firm, we work with Retirement & Medicare Together to serve the Medicare needs of our clients. For veterans and others, if you are turning 65 and getting ready to enroll in Medicare, please reach out to them or another experienced and independent Medicare insurance agent. In addition, if you or a loved one have not yet done Incapacity Planning, Estate Planning, or Long-Term Care Planning, please contact us:
Northern Virginia Medicare Planning: 703-691-1888
Fredericksburg, Veterans’ Planning: 540-479-1435
Rockville, MD Long-Term Care Planning: 301-519-8041
Annapolis, MD Elder Care: 410-372-4444
Washington, DC Elder Law: 202-587-2797
About Evan H Farr, CELA, CAP
