Learn how your VA Benefits and Original Medicare work
VA Benefits and Medicare: What You Need to Know
As a Medicare-eligible Veteran, you have options when it comes to healthcare. The transition to Medicare can be confusing, so this article will list a few points that all vets should know when they become Medicare eligible. To confirm your options call the Veterans Administration directly at 1-877-222-VETS (8387).
VA Benefits and Medicare
It is important to note that Veteran’s (VA) plans and Medicare do not supplement each other. In other words: VA plans only cover care at VA facilities, and Medicare only covers care at Medicare assigned doctors and hospitals. These plans do not overlap.
Should You Enroll in Medicare Part A If You Have VA Benefits?
Yes. You can have both Medicare and Veterans (VA) benefits at the same time. It is strongly recommended that all veterans enroll in Medicare Part A (Hospital Coverage) when they turn 65 and generally there is no additional cost for Part A. This will allow you receive hospital coverage should you go to a non-VA facility. According to the VA’s website “[We] encourages you to keep your private [Medicare] health insurance.” Source: VA.gov
Should You Get Medicare Part B If You Have VA Benefits?
Yes, It is strongly recommended that all veterans enroll in Medicare Part B (Medical Coverage) as well as part A when they are eligible. (Click here to learn more about when to enroll.) There is a monthly fee for Part B but it is worth it. If your VA Benefits are dropped at some point OR, and this is important, if your local VA facility does not cover all health services, you could pay 100% out of pocket for a serious illness. The VA highly recommends that you enroll in Part B as well. Please contact Veterans Affairs directly (1-877-222-VETS (8387)) with questions about specific care at Togus or another local facility.
Should You Get a Medigap or Medicare Advantage If You Have VA Benefits?
If you would prefer to see a local doctor or go to a local hospital or healthcare facility for your care then you should consider a Medicare Advantage or Medigap plan to supplement your Medicare coverage. Read more about these types of plans here.
Most people agree that veterans do not need a Medigap plan if they qualify for ChampVA. However, if you aren’t enrolled in ChampVA, a Medigap plan will fill in the gaps such as deductibles, copays, and coinsurance, as well as other benefits when seeking care outside of the VA, or outside of the U.S. and its territories. Make sure to speak with your Tricare or CHAMPVA representative before enrolling in any supplemental plan to ensure that it is actually beneficial for you. Here are two reasons why you may want to enroll in a private Medicare Supplement plan:
You do not live near a VA facility
You are enrolled in one of the VA lower priority groups, and could potentially lose your benefits*
* “There is no guarantee that in subsequent years Congress will appropriate sufficient funds for VA to provide care for all enrollment Priority Groups. This could happen if you are enrolled in one of the lower Priority Groups. This would leave you with no health care coverage.” Source: VA.gov
The choice of whether to enroll in Part D is up to you. In most cases, you don’t need a Medicare Prescription Drug Plan, aka Medicare Part D, as VA plans may offer more coverage than Medicare’s Rx coverage. Remember that any prescription prescribed by a non-VA doctor needs to be approved by your VA doctor for the VA to approve it. This may take extra time and your VA doctor can say that prescription is unnecessary.
What about the Part D Penalty?
Good news! Your VA drug coverage is considered creditable coverage so the Part D late enrollment penalty does not apply to you. If you choose not to enroll in Part D when you are first eligible you can still enroll later on in Part D without paying a penalty.
For further questions about Medigap, Medicare Advantage or Medicare Part D, please call the number above or book an appointment to meet and discuss your options. You can use the BOOK APPOINTMENT button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started – your choice!
Please note: We are only able to give general information about Medicare related issues. If you have questions about your VA coverage, please contact Veterans Affairs directly.
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