Did you know that according to the US Census Bureau in 2019 just over 50% of US veterans were aged 65 and older? This is significant because it speaks to the number of Medicare eligible veterans in the US. There are even more veterans eligible for Medicare due to disability or End Stage Renal Disease. A 2016 report showed of all the veterans enrolled in the Veterans Health Administration (VHA) health care system, only 12% of veterans under the age of 65, and eligible for Medicare, were actually enrolled in Medicare as compared to 98% of veterans 65 and older. This data could be indicative of a misconception that Veterans Affairs (VA) benefits cover all medical needs or that care was not needed outside of the VA.
My father was an Army Veteran who had utilized Indian Health Services (IHS) and the VHA for his medical care and prescription drugs for as long as I can remember. I did not quite understand why he chose to have both medical providers back then but have realized that his total care was not covered under just one service. Just before my dad passed, I discovered he had also began using a Medicare Advantage plan (the benefits and repercussions of combining IHS and Medicare will be discussed in another article). Now this was a time when I was very new to Medicare and still trying to grasp a good understanding of how everything worked. What I have discovered is that Medicare can be combined with other insurance plans, specifically benefits provided through VHA. Some veteran beneficiaries are not aware that you can even combine Medicare Advantage plans or Prescription Drug Plans with your VA benefits without losing those benefits. But, as a matter of fact, the Veterans Administration even recommends signing up for Medicare Parts A and B when you become eligible. Here a few things you should know about combining benefits:
Medicare Benefits That Can Be Combined With VA Benefits
o Original Medicare Parts A and B
o Medicare Advantage Plans (MA)
o Medicare Advantage with Prescription Drug Plans (MAPD)
o Standalone Prescription Drug Plans (PDP)
Reasons Why Medicare Plans Work With VA Benefits
o Veterans Affairs benefits primarily only cover services received at a VA facility or authorized services.
o Medicare will help cover non-VA facility visits and services.
o Veterans Affairs must authorize services needed at non-VA facilities, having to meet a strict criteria for approval.
o Veterans Affairs may not cover prescriptions prescribed by private or community physicians that have not been authorized.
o MAPD plans and PDP can help cover costs of prescription drugs prescribed by physicians at non-VA facilities.
Reasons A Medicare Eligible Veteran Should Choose to Enroll In A Medicare Plan
o Enrollment in both VA benefits and Medicare provides more flexibility in healthcare choices.
o A choice of healthcare programs to use when being treated.
o Coverage when a VA facility or services cannot be used (for instance, due to distance or care needed outside of a VA facility)
o Prescription drug coverage for medications not included on the Veterans Affairs formulary.
o Additional benefits from a MAPD plan which may include dental, vision, fitness, hearing, OTC savings, podiatry, chiropractic or counseling.
o VA beneficiaries can still receive care at VA or VA approved facilities using VA benefits.
Eligibility And Requirements For Medicare and Medicare Advantage Plans
o Must be eligible to enroll in Medicare (65 years or older, under 65 with ESRD or ALS)
o Must be enrolled in Medicare Part B
Food For Thought Before Signing Up For Medicare Or Medicare Advantage Plans
o U.S. Department of Veterans Affairs and Medicare will not pay for the same services or items.
o Veterans Affairs will pay for services at a VA facility or authorized services in a non-VA facility.
o Medicare pays for Medicare-covered services or items at a non-VA facility.
o In the case Veterans Affairs authorizes partial services in a non-VA hospital, Medicare may pay for the Medicare-covered services that the VA did not authorize during a hospital stay.
o Prescriptions prescribed by a private or community physician may not be covered if the veteran has a Medicare Advantage only plan that does not include a prescription drug benefit.
o The VA provides creditable coverage for Medicare Part D, but not for Part B.
o Late Part B enrollment will result in a late enrollment fee if you do not enroll in Part B when first eligible.
o Veterans Affairs criteria to see a non-VA provider and have prescriptions filled by the VA*:
• You must be enrolled in VA healthcare
• You need to have a primary-care provider assigned by the VA
• You must provide your VA healthcare provider with medical records from your non-VA provider
• Your VA healthcare provider has to agree with the medication prescribed by your non-VA provider.
• Your VA healthcare provider is under no obligation to prescribe a medication recommended by a non-VA provider.
* Must meet ALL of the conditions above
NOTE: Original Medicare or Medicare Advantage plans and VA services can also be combined with TRICARE For Life (TFL). A TFL beneficiary will be a person who is retired from the military, eligible for Medicare, and enrolled in Part B.
It can certainly be beneficial for veterans to combine coverage in order to maximize care. One thought to keep in mind, though, is that it is always a good practice to alert your doctors of the care you are receiving care outside of the VHA health care system in order for your health care to be coordinated.
Contact a licensed agent at Centsable Dollar to help find a plan that is right for you.
Call 602.510.9441 or email info@centsabledollar.com.
Related Articles
What To Do If You Miss Your Initial Enrollment
SSI and VA Recipients with Dependents Get Additional Economic Impact Payments
Resources
US Census Bureau – Veteran Status
US Department of Veterans Affairs – VA and Other Health Insurance
Medicare.gov – How Medicare works with other insurance
Forbes.com – Veterans: Pay Attention To Medicare At Age 65 Or Face Problems Later
