Cost Shifting from Medicare Advantage to the Veterans Affairs Health System
Veterans who have healthcare benefits through both Medicare and the Department of Veterans Affairs (VA) are increasingly enrolling in Medicare Advantage (MA) plans. For veterans who have both VA and MA coverage, there are no rules for determining which program should pay first (often called “payer precedence”).
In the absence of such rules, these dual beneficiaries have overlapping coverage, which creates an incentive for MA organizations to enroll veterans to obtain monthly premium payments, but then steer them to VA-financed care and to maximize revenue. Duplicative care is potentially very costly to the government and little is known about the strategies MA organizations may use to shift costs to the VA.
Susan Joy
Managing Director
MA can help provide comprehensive coverage for veterans with VA health benefits, however, the current system incentivizes MA organizations to target veterans for profit rather than to ensure they receive optimal care.
Susan Joy
Managing Director
AIR's Research and Publications
For this project, AIR conducted qualitative and quantitative research to understand how MA organizations may be using geographic location, plan design, chart reviews and health risk assessments, and marketing to target veterans and encourage them to maximize their use of VA benefits. AIR is publishing a series of issue briefs discussing our findings:
