May 29, 2018
By: The My Medicare Matters Team
While
most people 65 and older get their health care through Medicare, if you are a
veteran (or family member of a veteran) you are eligible for additional
healthcare options that can provide coverage in addition to Medicare. You may
already have healthcare coverage either through VA benefits (administered through the
Department of Veterans Affairs), TRICARE (administered
through the Department of Defense) or CHAMPVA(administered by
the Department of Veterans Affairs Chief Business Office Purchased Care), so
Medicare can coordinate with these programs in different ways.
This
post will help guide you through using your Medicare in conjunction with your
existing veteran healthcare options.
I have VA benefits. Do I need to enroll in Medicare Part A and
Part B?
It’s often
advisable to join Part A and Part B if you’re eligible for
it at age 65 since it covers inpatient hospitalizations, hospice, skilled
nursing care, and outpatient care from non-VA providers. Enrolling can prevent
gaps in coverage and help you avoid Medicare late enrollment penalties if you
decide to join later. Part A is typically free for most people and Part B has
a monthly premium.
However,
if you are enrolling in TRICARE For Life you must be enrolled in
Original Medicare (Parts A & B).
How do Medicare and VA benefits work together?
Medicare
and VA benefits rarely coordinate benefits which is why Veterans with VA
benefits are encouraged to enroll in Medicare Parts A & B.
Medicare does not cover services received at VA facilities and the VA will not
pay for services obtained from non-VA providers (doctors and hospitals).
Veterans who want treatment or care from non-VA providers should join Medicare
Parts A & B.
Keep in
mind, not all veterans are eligible for the same level of VA services. VA
priorities may shift based on congressional appropriations, and veterans in
lower-level priorities could see changes (possibly decreases) in their benefits
over the years. If a veteran were to lose their VA coverage and join Medicare
Parts A & B, then the 10% late enrollment penalties would apply for Parts A
& B for each year of delayed enrollment.
I have both Medicare and VA coverage. Who pays first?
If you
have both Medicare and VA benefits, your eligible for treatment under either
program. You must select which system to use each time you receive any form of
healthcare. Medicare only pays for care delivered by Medicare-certified
facilities. To get the VA to pay for services, you must go to a VA facility or
have the VA authorize services in a non-VA facility. If the VA authorizes
services in a non-VA hospital but doesn’t pay for all of the services you get
during your hospital stay, then Medicare may pay for a portion of
Medicare-covered services.
I get my prescriptions from the VA. Do I need Medicare Part D
prescription drug coverage?
Typically,
veterans use the VA prescription drug benefits instead of Medicare Part D because
it has lower out-of-pocket costs than Medicare Part D. However,
anyone who is enrolled in Medicare Part A and/or B can join Medicare Part D.
You may want to consider joining if any of these situations apply to you:
·
Your prescriptions are not listed on the VA’s covered drugs
list, also called a “formulary”
·
You take prescription drugs prescribed by non-VA physicians and
fill the prescriptions at a local retail pharmacy
·
You qualify for Medicare’s Extra Help program, and
therefore Part D offers drug copayments lower than VA copayments
VA
and TRICARE coverage is creditable coverage, meaning there are
no late enrollment penalties for joining Part D later.
To
learn more about your VA benefits and Medicare enrollment choices you should
contact the Department of Veterans Affairs. If you need
help selecting a Medicare plan that works with your Veterans benefits try
taking our Medicare Questionnaire assessment,
which can connect you to free professional advice about Medicare from a
licensed benefits advisor. You can also call your local State
Health Insurance Assistance Program (SHIP) for federally-funded
Medicare counseling.
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