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  • Writer's pictureMike Layden, CPA

VA Benefits Medicare Springfield IL

Updated: May 20


Department of Veteran Affairs Sign

Written by Mike Layden, CPA

President Health & Life Solutions, Inc.

217-290-1768



There are many veterans questions about Medicare in Springfield IL. If you have other forms of health care coverage (like a private insurance plan, Medicare, Medicaid, or TRICARE), you can use VA health care benefits along with these plans. Learn more about how VA works with other health insurance. VA benefits add additional healthcare for veterans and medicare.


VA Benefits Medicare


The purpose of this article is to answer many of the most common veterans questions about Medicare in Springfield IL. We have attempted to identify those questions most often asked. If you have other questions that are not presented in this article, please let us know. We will answer your questions and update this article, as well. We can be reached at 217-290-1768. By the way, we are veteran owned.


Why does VA benefits require me to provide information on my health insurance coverage (including coverage under a spouse’s plan)?


The VA asks for this information because they have to bill your private health insurance provider for any care, supplies, or medicine we provide to treat your non-service-connected conditions (illnesses or injuries that aren’t related to your military service). They don’t bill Medicare or Medicaid, but may bill Medicare supplemental health insurance for covered services.


What if my health insurance provider doesn’t cover all the non-service-connected care that VA bills them for?


You won’t have to pay any unpaid balance not covered by your health insurance provider. But, depending on your assigned priority group, you may have a copay for non-service-connected care. Learn more about eligibility priority groups


Does it help me in any way to give VA my Understanding VA Healthcare Benefits for Veterans Medicare Enrollment health insurance information?


Yes. Giving the VA your health insurance information helps you because:

  • When your private health insurance provider pays us for your non-service-connected care, they may be able to use the funds to offset part—or all—of your VA copayment.

  • Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care).

Does my current health insurance status affect whether I can get health care through VA benefits?


No. Whether or not you have health insurance coverage doesn’t affect the VA health care benefits you can get.


Note: It’s always a good idea to let your VA doctor know if you’re receiving care outside VA. This helps your provider coordinate your care to help keep you safe and make sure you’re getting care that’s proven to work and that meets your specific needs.


Does a Veteran Need Medicare or Other Insurance?


This is your decision. You can save money if you drop your private health insurance, but there are risks. We encourage you to keep your insurance because:


  • VA doesn't normally provide care for Veterans’ family members. So, if you drop your private insurance plan, your family may not have health coverage.

  • The VA does not know if Congress will provide enough funding in future years for us to care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future. If you don’t keep your private insurance, this would leave you without health coverage.

  • If you have Medicare Part B (coverage for doctors and outpatient services) and you cancel it, you won’t be able to get it back until January of the following year. You may also have to pay a penalty to get your coverage back (called reinstating your coverage).

Health & Life Solutions, Inc. encourages you to sign up for Medicare as soon as you can. This is because:


  • Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from.

  • Funding for VA health care could change in the future. We encourage you to sign up for every health care benefit that you’re eligible for so you have options if you need them.

  • If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a penalty. This penalty gets bigger each year you delay signing up—and you’ll pay it every year for the rest of your life.

  • If you sign up for Medicare Part D (coverage for prescription drugs), you’ll be able to use it to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy instead of through the VA mail-order service. There’s no penalty for delaying Medicare Part D as long as you enroll when you’re first eligible or within 63 days of when you no longer have VA health care or other creditable prescription drug coverage. Learn more about how to avoid the Part D penalty on the Medicare website

You’ll need to choose which benefits to use each time you receive care.

To use VA benefits, you’ll need to get care at a VA medical center or other VA facility. The VA will also cover your care if they pre-authorize you (meaning we give you permission ahead of time) to get services in a non-VA hospital or other care setting. Keep in mind that you may need to pay a VA copayment for non-service-connected care.


If you go to a non-VA (or VA authorized) care facility, Medicare may pay for other services you may need during your stay. Or, if we only authorize some services in a non-VA location, then Medicare may pay for other services you may need during your stay. Check your Medicare plan, so you know which care locations and services you’re covered for. Learn more about Medicare


The VA may bill and accept reimbursement from High Deductible Health Plans (HDHPs) for medical care and services to treat your non-service-connected conditions. If you have an HDHP linked to an HSA, you can use your HSA to pay your VA copayments for non-service-connected care.


The VA may also accept reimbursement from HRAs for care we provide to treat your non-service-connected conditions.


As a result of the VA MISSION Act of 2018, the VA no longer needs permission to bill health insurance providers for care related to a sensitive diagnosis (like alcohol or drug abuse, alcoholism, HIV or HIV testing, sickle cell anemia, or other diagnoses included in Public Law 38 U.S.C. §7332-protected information).

Before submitting any claims for care related to a sensitive diagnosis, VA notified Veterans of this change by sending a one-time notice to all Veterans who had signed a release of information refusing to allow us to bill for care related to a sensitive diagnosis in the past. The Federal Register also published this change.


We’re now submitting claims to health insurance carriers for all non-service-connected care, even if the VA do not have a signature or written authorization permitting us to disclose protected information on these claims or in Veterans’ medical records.


The VA is required by law to bill your health insurance (including your spouse’s insurance if you’re covered under the policy). The money collected goes back to VA medical centers to support health care costs provided to all Veterans.

You can submit a restriction request asking us not to disclose your health information for billing purposes, but we’re not required to grant your request. To submit a restriction request, please contact your nearest VA health facility and ask to talk with the privacy officer. You can also ask to talk with the billing office for more information.


Do veterans get extra Medicare benefits?


Yes, veterans may be eligible for extra Medicare benefits through programs like Veterans Affairs (VA) health care. These benefits can include coverage for services not typically covered by Medicare, such as long-term care or mental health services. It's important for veterans to explore their options and see if they qualify for additional benefits to ensure they receive the care they need.


Are veterans automatically enrolled in Medicare?


No, veterans are not automatically enrolled in Medicare. However, many veterans may be eligible for both Medicare and benefits through the Department of Veterans Affairs (VA). It's important for veterans to understand their options and enrollment requirements for each program. If you're a veteran, be sure to check your eligibility for both Medicare and VA benefits to make the most of your healthcare coverage.


Can a Veteran have Medicare and VA benefits?


Yes, Veterans can have both Medicare and VA benefits. It is possible to be eligible for and receive benefits from both programs at the same time. In fact, many veterans choose to enroll in both Medicare and utilize their VA benefits to access a wider range of healthcare services. It's important to understand how each program works together to ensure you receive the comprehensive care you deserve.


Should I get Medicare Part B if I have VA benefits?


If you have VA benefits, it's recommended to enroll in Medicare Part B as well. This will provide you with additional coverage and ensure that you have access to a wider range of healthcare services. Plus, having both types of coverage can help you save money in the long run by reducing out-of-pocket costs. So, yes, getting Medicare Part B alongside your VA benefits is a smart decision to make sure you have comprehensive healthcare coverage.


Should I opt out of my other insurance plans (such as Tricare for Life or Medicare) if I’m accepted into the VA health care program?


If you're accepted into the VA health care program, you may wonder if you should opt out of your other insurance plans like Tricare for Life or Medicare. It's important to consider your individual situation but generally, keeping your other insurance coverage can provide you with additional options and benefits. VA health care is a great resource, but having multiple forms of coverage can ensure you have access to a wider range of services and providers. Plus, having a backup plan is always a smart move. Be sure to carefully weigh your options and consider speaking with a trusted advisor before making any decisions.


Conclusion


Obtaining expert advise from our Advisors at Health & Life Solutions, Inc. is recommended if there is a veteran wrangling benefits from Medicare, Department of Veteran Affairs or Tricare For Life.  We will ensure you receive the maximum health benefits you deserve.  Our firm is Veteran-owned and understands the complications of veteran healthcare.  Give us a call at 217-290-1768.


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