Veterans leaving active duty may be eligible for healthcare benefits from the Department of Veterans Affairs (VA) or TRICARE. In some cases, they may be eligible for both. They are also eligible for Medicare when they turn 65.
Do Veterans Have to Enroll in Medicare?
Veterans don’t have to enroll in Medicare, but the U.S. Department of Veterans Affairs recommends they enroll when they turn 65, even if they have VA benefits. Not enrolling at 65 could result in a late enrollment penalty, which increases the longer veterans delay enrollment. Just like everyone else turning 65, they have the option to enroll in Original Medicare or a Medigap, Part D, or Medicare Advantage plan.
Why Should You Help Veterans Enroll in Medicare?
There are three key reasons that it may be advantageous for your veteran clients to enroll in Medicare:
1. They gain more options for where to receive care. Vets can receive care from both VA-approved facilities and non-VA facilities. VA facilities are often more economical, but there are limited locations, often longer wait times, and lower patient satisfaction rates.
2. They can worry less about future funding for VA benefits. If funding for VA healthcare is reduced in the future, those in lower-priority groups could be at risk of losing their VA benefits. There are eight priority groups based on service history, disability rating, income, Medicaid eligibility, and receipt of additional benefits. Vets who lose VA benefits and have not enrolled in Medicare during their IEP will face late enrollment penalties if they enroll at a later date.
3. They may receive additional benefits with Medicare. Medicare may offer additional benefits, including hospice care, skilled nursing facility care, and durable medical equipment (DME) benefits. Most Medicare Advantage plans offer supplemental benefits that may be beneficial for veterans, such as gym memberships, transportation to medical appointments, meals after a hospital stay, and OTC rewards. Some vets may qualify for vision and dental benefits through the VA. Those who don’t may want to consider adding these benefits through a Medicare Advantage plan.
What About Part D Benefits?
Veterans with VA benefits or Tricare for Life have prescription drug coverage and are not required to enroll in Part D, but there are several reasons why vets might want to consider adding Part D coverage:
- A specific drug not covered by their veteran’s benefits might be covered by a Part D plan.
- If they qualify for Extra Help, they can receive help paying for their medications.
- They will have a wider selection of pharmacies where they can fill their prescriptions.
- If they are in a nursing home outside the VA health system, Part D will cover their prescriptions.
Vets can enroll in a Part D plan at any time and there is no late enrollment penalty.
Qualifying Based on Disability
Qualifications for benefits based on disability differ for the VA and Medicare. To receive disability benefits through the VA, applicants must have a disabling condition that was caused by or worsened due to active duty. Veterans who were discharged may not be eligible for disability benefits.
To qualify for Medicare due to a disability before the age of 65, the individual must either have received Social Security Disability Insurance for at least 24 months, have end-stage renal disease, or have Lou Gehrig’s disease (ALS). The disability doesn’t have to be service-related, but it must render the individual unable to perform substantial work and must last or be expected to last at least a year. The vet’s discharge status isn’t taken into account.
Does Medicare Coordinate Benefits With the VA?
Coordination of benefits depends on the type of coverage the vet has:
VA Benefits
Medicare and the VA do not coordinate their services. This means each time veterans receive a healthcare service, they must choose which program’s benefits to use. In most cases, they will use VA benefits when accessing care at VA facilities and their Medicare card at other facilities. Medicare and the VA cannot pay for the same items or services – it is one or the other.
Tricare and Tricare for Life
Tricare is the healthcare coverage offered to active duty military members who qualify. When they turn 65, they need to enroll in Medicare Part A and Part B during their Initial Enrollment Period (IEP), and Tricare automatically transitions to Tricare for Life (TFL). They must maintain their Medicare coverage to keep TFL.
Unlike VA benefits, Medicare and TFL do coordinate benefits. Tricare is the secondary payor to Medicare – any amount Medicare does not cover will be sent to TFL for payment. TFL typically covers any deductibles, copays, and coinsurance that Medicare does not cover.
Some vets may have both VA benefits and TFL. These do not coordinate with each other. Vets must choose which benefits to use when receiving care.
Your Support is Invaluable
As a Medicare agent, you play an important role in educating veterans about their healthcare options. Making sure they enroll in a Medicare plan will provide them with additional peace of mind that they will the healthcare resources needed, now and in the future.
The dedicated team at Western Asset Protection is here to support you in achieving your career goals. Contact us today.