More than 16 million veterans are in the U.S., nearly 50% of whom are 65 or older. This represents a unique opportunity for Medicare agents who are educated in veteran’s benefits and know how these benefits work in conjunction with Medicare. You can be an important advocate for this demographic, assisting veterans in making the right decisions for their health care coverage.
Army, Navy, and Air Force, Marine veterans who did not receive a dishonorable discharge may qualify for health care benefits administered through the Veterans Administration (VA). When veterans apply for VA benefits, they are assigned one of eight priority groups, with one being the highest priority. This determines when the veteran’s benefits begin, what the benefits cover, and what the out-of-pocket costs will be.
Vets’ priority groups are based on their service history, disability rating, income, eligibility for Medicaid, and whether they receive additional benefits. Priority groups can change over time – for example, in the case of income changes or if a service-related disability worsens.
Medicare and VA Benefits
Although Medicare is not a requirement for veterans who have VA benefits, the U.S. Department of Veteran Affairs encourages vets to enroll in Medicare Part A and B during their Initial Enrollment Period when they turn 65. Since VA benefits include prescription coverage, it is not necessary for them to enroll in a Part D Plan.
There are several compelling reasons why vets with VA benefits should consider enrolling in Medicare:
- Having coverage through both military benefits and Medicare means wider access to care, giving the veteran more choices for treatment. Medicare coverage is particularly beneficial for those who don’t live near a VA facility and whose local facilities have long wait times. Furthermore, having Medicare can be helpful in the event of an emergency far from a VA hospital.
- Many Medicare Advantage (MA) plans offer an array of desirable supplemental benefits, including coverage for dental, hearing, and vision services. Additional MA benefits may include wellness and gym benefits, meals after hospital stays, transportation to medical appointments, and over-the-counter medications.
- Veterans who enroll in Medicare and have limited income and resources might be eligible for one of the four Medicare Savings Programs to help offset some of their out-of-pocket expenses.
Encourage vets to consider their future needs. For example, they may move and no longer be close to a VA facility or, if their health changes, they may want the option to use non-VA doctors and hospitals. Enrolling in Medicare provides flexibility to address unexpected events.
Medicare and the VA Do Not Coordinate Benefits
The VA and Medicare provide distinct coverages that do not overlap or coordinate. This means vets need to decide which program’s benefits to use each time they receive care. Vets must use a VA facility to use their VA coverage and a civilian, non-VA facility to use Medicare coverage. The exception is when the VA authorizes care at a non-VA facility. This happens only in specific circumstances, such as when a VA facility is geographically inaccessible to the vet.
TRICARE is the healthcare coverage available to active-duty military personnel who qualify. When vets with TRICARE turn 65, they must enroll in Medicare Parts A and B during their IEP. On the date their Medicare becomes effective, their TRICARE automatically transitions to TRICARE For Life (TFL). If they fail to sign up for Medicare, their TRICARE coverage ends. Vets with TFL have prescription coverage through TRICARE’s Pharmacy Program and do not need to enroll in a Part D plan.
Medicare and TRICARE For Life
Unlike the VA, Medicare and TFL do coordinate benefits. TFL acts as a secondary insurance to Medicare. For example, if a vet has a Medicare Advantage plan, the MA plan is the primary payer and sends any unpaid amount to TFL for processing and payment. TFL typically covers the deductibles, copays, and coinsurance the MA plan doesn’t cover.
VA Benefits and TRICARE
A vet can have both VA benefits and TRICARE. Since these two coverages do not coordinate care, the vet must choose which benefits to use when receiving care.
Why Veterans Should Consider Adding Part D Coverage
Veterans with VA benefits and TRICARE For Life have prescription drug coverage. This is creditable coverage, meaning vets do not need to enroll in Part D. Enrolling into a part D plan could potentially cancel your VA prescription drug coverage – always check with your Tricare office, however there are some circumstances where vets might benefit from adding a Part D plan:
- They want to access a wider range of pharmacies to fill their prescriptions.
- Neither the VA nor TRICARE covers a specific drug, but the drug does appear on the formulary of a Medicare Part D plan.
- They qualify for Extra Help, the federal low-income program that can help them afford their drug costs.
- They are in a nursing home outside the VA health system and need medications from the nursing home pharmacy.
- A non-VA facility may prescribe drugs that the VA benefits don’t cover without authorization. With TFL, vets may be able to receive prescriptions from a non-network pharmacy, but they will have to pay upfront and submit a claim for reimbursement.
A veteran with VA benefits or TFL may choose to enroll in Part D at a later time and will not face a late enrollment penalty.
You can play an important role in helping veterans understand how Medicare can complement their military benefits and give them peace of mind knowing they have the coverage they need and deserve.
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