A bipartisan group of lawmakers is introducing legislation that would allow the Department of Veterans Affairs to bill Medicare Advantage plans for care provided to members, the Wall Street Journal reported June 23.
A study published in Health Affairs in November found Medicare Advantage plans were paid more than $1 billion for veteran enrollees who did not use any Medicare services. The VA generally does not bill Medicare, but may bill Medicare supplemental plans for covered services.
Sen. Elizabeth Warren, a sponsor of the legislation, told the WSJ that insurers are exploiting a “costly loophole.”
The federal government effectively pays twice when veterans enrolled in an MA plan receive care through the VA. MA plans may receive duplicative payments because CMS pays MA plans a fixed amount per member, per month, regardless of the care they use, according to the study in Health Affairs.
The VA encourages veterans to enroll in Medicare, the WSJ reported, so they have the choice of utilizing care outside of the VA. Around 1 in 3 veterans enrolled in Medicare were enrolled in MA plans in 2022, according to the study.
Humana is the largest provider of MA plans to veterans. The insurer told the journal it strongly supports “increased coordination between [Medicare] and VA to better ensure beneficiaries have seamless access to healthcare coverage they have earned through the VA and Medicare.”
Read more here.
