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Veterans, Thank You for Your Service

Veterans have served our country with selfless sacrifice and devotion to the greater good of our country. Comprehensive healthcare is not just a need; it's a well-deserved right. While the Department of Veterans Affairs (VA) provides valuable healthcare services, many veterans are eligible for additional care through Medicare. The combination of Medicare and VA benefits can create a powerful healthcare solution. We will explore the critical  questions every Veteran should understand when becoming eligible for Medicare.  Included in this article is how Medicare impacts a veteran who may be receiving benefits from the Veteran Affairs or Tricare for Life. 

Combinations of Veteran Healthcare

  • VA Benefits 

  • VA Benefits + Original Medicare + Medigap

  • VA Benefits + Original Medicare + Medigap + Part D prescription drug coverage.

  • VA Benefits + Original Medicare + MA (Medicare Advantage Plan with NO Part D prescription drug coverage included.)

  • VA Benefits + Original Medicare + MAPD (Medicare Advantage Plan with Part D prescription drug coverage included.)

  • Original Medicare + Tricare For Life

  • Original Medicare + Tricare For Life + MA (Medicare Advantage Plan with NO Part D prescription drug coverage included.) 

Coverage Combinations Explained

The following discussion of coverage combinations explained will be limited to the coverages highlighted in blue above.  The reason is that it is believed the other coverage options are self explanatory.

VA Benefits

  • If you only have coverage through VA benefits, your healthcare may be limited. Veterans may only receive care at a VA facility unless otherwise pre-approved by the VA. However, even with approvals, there are hurdles to jump. Often, such approvals can take weeks or months to process.

  • Prescription benefits received at the VA are considered creditable.

  • Healthcare received must be at VA facility or have been preapproved by the VA at a facility not affiliated with the VA.

KEEP IN MIND

  • If do not enroll in Part A and Part B when you are eligible and you later decide you would like the additional coverage, you will pay an enrollment penalty.  The penalty will grow each year and it will be with you for your lifetime.

  • You will not incur the Part D enrollment penalty if you delay that enrollment.

  • You can have VA benefits and Medicare without threatening the benefits you already receive from the VA.

VA Benefits + Original Medicare + MA (Medicare Advantage Plan with NO Part D prescription drug coverage included.)

  • This may be appealing to you if you want to receive original Medicare from a private insurance company.

  • These plans were designed with the veteran in mind.

  • They may offer additional benefits not available with Original Medicare such as dental, vision, and hearing.

  • Since the veteran already has creditable prescription coverage from the VA, prescriptions are not a component of this type of plan.

  • The Humana Honors Plan provides a Part B give back plan which adds up to $125 per month back to your Social Security Check.

KEEP IN MIND

 

This type of combination may be beneficial to the veteran if they are satisfied with the prescription benefit provided by the Veterans Administration.  Since the VA and Medicare do not coordinate their benefits, the veteran should understand that they will not have prescriptions covered by their private doctor.  They will only be covered by the VA.  

OR CHOOSE

Original Medicare + Tricare For Life + MA (Medicare Advantage Plan with NO Part D prescription drug coverage included.) 

  • This may be appealing to you if you want to receive original Medicare from a private insurance company.

  • These plans were designed with the veteran in mind.

  • They may offer additional benefits not available with Original Medicare such as dental, vision, and hearing.

  • Since the veteran already has creditable prescription coverage from the VA, prescriptions are not a component of this type of plan.

  • The Humana Honors Plan provides a Part B give back plan which adds up to $125 per month back to your Social Security Check.

KEEP IN MIND

 

It is possible to enroll in a Medicare Advantage plan if you already have Tricare For Life.  The primary benefits of doing this would be to effectively reduce your health care costs by $125 per month or substantially increase the amount of comprehensive dental benefits you might receive.  This decision should only be elected when your healthcare providers know how to bill Tricare for Life and Medicare.  Because remember, Tricare For Life is a comprehensive health insurance plan that usually covers all or most of the services that a Medicare Advantage plan would cover.   Tricare for Life has a broad network while an Advantage Plan typically has a more restrictive network.

Veteran Frequently Asked Questions

Is It a Good Idea to Enroll in Medicare When I have Other Forms of Veteran Health Insurance or Healthcare?

It is generally a good idea to enroll in Medicare even if you have other forms of veteran health insurance or healthcare. Medicare can provide additional coverage and benefits that may not be provided by your other insurance. In addition, having both Medicare and other insurance can help cover more of your healthcare costs and provide you with more options for treatment. It is important to review your specific situation and consult with a healthcare professional to determine the best course of action for your individual healthcare needs.

Will enrolling in Medicare Part A & Part B or a Medicare Advantage Plan Effect My VA Health Care Eligibility and Benefits?

Enrolling in Medicare or a Medicare Advantage Plan will not affect your eligibility for VA health care. VA health care is separate from Medicare and having Medicare coverage will not impact your access to VA benefits. Additionally, having both Medicare and VA health care coverage can provide you with comprehensive health care coverage and access to a wider range of services and providers.

Are veterans required to enroll in Medicare?

If you have Veterans Administration (VA) benefits, you are not required to enroll in Medicare to keep them. However, the VA recommends enrolling in Medicare when you become eligible. Enrolling in Medicare gives veterans more coverage choices when choosing hospitals or medical care.

The VA has stated in the past that coverage for aging veterans may fluctuate due to congressional budgetary constraints. By enrolling in Medicare, you have secured coverage no matter what happens in Washington, D.C.

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.

You must enroll in Medicare Part A and Part B to initiate Tricare For Life coverage.

Do I have to enroll in Medicare if I plan on working after 65?

If you have creditable insurance coverage from an employer and plan to work past 65, you may be able to delay Medicare Part B enrollment without penalty. Without creditable coverage, delaying enrollment can lead to late enrollment penalties. If this applies to you, consult a Medicare professional who can guide you so you do not incur Part B enrollment penalties.

Can Medicare and VA benefits overlap?

You can have both VA benefits and Medicare. However, coverage does not typically overlap. 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. You will need to choose which coverage you use for each service you receive.

To use VA benefits, you’ll need to get care at a VA medical center or other VA location. We’ll also cover your care if we 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 VA benefits 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

Will Medicare and the VA coordinate coverage?

Medicare and the VA do not coordinate coverage. This means they will not jointly pay for a medical bill. The only scenario where they might team up to provide dual coverage is when the VA approves care to be received at a non-VA facility. But even under that circumstance, dual coverage is not guaranteed and should not be relied upon.

Can I be penalized if I have VA coverage and enroll in Medicare after age 65?

As with any other American who is eligible for Medicare and does not sign up during their Initial Enrollment Period, you may be subject to late enrollment penalties if you decide to sign up later.

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 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).

Will my VA coverage stay the same forever?

One of the most important reasons the VA recommends veterans enrolling in Medicare as soon as you become eligible is because your VA coverage is subject to change. That could leave you without the health insurance coverage you need when you need it most.

VA health benefits are funded by Congress, and there may come a day when that funding is unable to fully cover all veterans in the system. To help secure your coverage, it is recommended that you enroll in Medicare as soon as possible.

Will my prescription drug coverage be affected?

Your Veteran Administration prescription drug coverage will not be affected. Many VA members choose not to enroll in Medicare Part D Prescription Drug Plans. And because VA drug benefits are considered “creditable coverage” by Medicare, VA members are not required to pay a late enrollment penalty if they choose to sign up for a Part D plan later.

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

What kind of Medicare plans are best for veterans?

Due to their variety of coverage and flexibility, Medicare Advantage plans are a coverage option that appeals to some veterans. These plans are sold by independent carriers and typically provide more benefits than Original Medicare (Parts A and B). For veterans who are used to receiving additional benefits, MA plans may be a good fit.

Of course, there is no “right” answer for everyone, and coverage needs vary. Talking with us at Health & Life Solutions, Inc. is a smart and simple way to learn more about how these coverage options work together for you.

Does it make sense to enroll in a Medicare Advantage Plan if I have tricare for life?

It may not make sense to enroll in a Medicare Advantage plan if you already have Tricare For Life, as Tricare For Life is a comprehensive health insurance plan that usually covers all or most of the services that a Medicare Advantage plan would cover. Additionally, enrolling in a Medicare Advantage plan may come with additional costs or restrictions that could outweigh any benefits it offers. It is best to consult with both Tricare For Life and the Medicare Advantage plan provider to determine the best option for your specific healthcare needs.

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