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One day I was in a Veterans Administration (VA) clinic waiting to be helped. I overheard a man complaining that he was charged over $1000 from the nearby military hospital for emergency services. Of course, I had no way of knowing this man’s VA status or the history of his military service, but he looked to be a Vietnam era veteran. While I did not really know anything about this fellow Veteran, I could not help but wonder what the circumstances were regarding this bill he received. He returned to his seat next to me, and I asked him if he tried submitting a claim to Medicare or his healthcare plan. He said he only received medical care from the VA and he did not have Medicare or any other healthcare insurance. I did not question him further, but it seemed like he did not understand he could have Medicare while using his VA benefits.
What options do Veterans have when it comes to healthcare after become Medicare eligible in civilian life?
Veterans can enjoy their VA benefits while making the most of their Medicare benefits at the same time, if they know how. The problem is, Medicare can seem complicated enough on its own. The veteran’s use of both Medicare and the VA might seem even more complicated; but with just a little knowledge about how these two benefits can work together, it can be a great help to some veterans. If you have worked at least ten years in the US and dutifully paid Medicare taxes (including while you were in the military), then you will likely be eligible if you meet the age or disability qualification standards (not your VA disability rating, but rather your qualification for Social Security disability).
Why have Medicare if you have VA benefits?
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The VA “encourages” Veterans to keep their private insurance. Here are several other reasons to have both Medicare and VA healthcare benefits:
- Is the VA facility/doctor easily accessible and within a reasonable driving distance?
Some of us live in communities with large populations of Veterans where the VA has an abundance of facilities and providers.
The VA “Choice” Program allows veterans to use community healthcare providers with VA authorization.
- Does the VA facility have the specialists and treatments you need for my situation?
VA Choice Program may be an option.
- What is your priority in the VA system?
The VA places Veterans into five categories or “priority” groups based on service rated disability and other service related factors.
- Do you want to risk a penalty for late enrollment in Medicare Part B if you need it later?
Medicare Part A is free to most eligible beneficiaries. Most beneficiaries are required to pay a premium for their Part B. VA coverage does not count as creditable healthcare coverage so a late enrollment penalty may be assessed if the veteran decides to enroll in Medicare after a period of eligibility.
- Do any of the Medicare plans available in your area offer services and benefits not offered by the VA.
Some Medicare Plans may offer additional benefits such as dental, vision, fitness club memberships, etc.
What options do Veterans have?
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- Obtain healthcare exclusively with the VA
I recommend before you take this option, veterans be aware of their priorities and the availability of service. In some cases, the VA may be able to provide all the services when and where they are needed.
- Use both VA Healthcare and Medicare
This option provides the most choices. This is where it seems some Veterans get confused. You can use both benefits, and while Medicare and VA do not coordinate coverage or treatment, they can be used together. Veterans will have to pay the Part B premium like everyone else, but the additional options in terms of healthcare providers may prove to be worth the premium. Part B premiums are set by the Center for Medicare and Medicaid Services (CMS) on a sliding scale according to income, but most middle-income earners (less than $170K annual income for a joint return or $85K annual income for a single) pay $134 per month. Additional premiums may also be required from the carrier.
- Use Medicare Some Veterans may feel they do not require healthcare from the VA at all and therefore, elect to use their Medicare benefit only.
There are programs to help low-income earners pay costs associated with Medicare. There are Special Needs Plans (SNP) that are tailored for both Medicaid eligible and people with certain chronic illnesses. Medicare has a website to explain these programs to help veterans (and other beneficiaries) apply. https://www.medicare.gov/your-medicare-costs/help-paying-costs/get-help-paying-costs.html
What about Prescription Drug coverage for Veterans?
While VA healthcare does not count as creditable coverage in the eyes of Medicare, VA drug coverage is creditable. That means a Part D or prescription drug plan is not required and Veterans with VA prescription drug coverage will not be subject to penalties for late enrollment in a Part D Prescription Drug Plan. Therefore, Veterans enrolled in the VA prescription drug system are not required to purchase a Prescription Drug Plan from a private company (although they can). Some Medicare Advantage Plans have prescription drug plans included, and others do not. Veterans who choose to have both Medicare and VA benefits may select Medicare plans that do not have the prescription drug plan included.
What about Veterans in a “retired” status?
Retired Veterans and other qualified Veterans and family members are eligible for “Tricare for Life” or TFL. TFL is a Medicare “wraparound” coverage that pays most of what is not covered by original Medicare. Those Veterans enrolled in TFL will have to pay their Medicare Part B premiums (unless they qualify for help paying for their Medicare benefits). TFL is usually recommended for retired and other qualified veterans and their families because of its comprehensive coverage and flexibility.
I hope I was able to shed some light on the choices veterans have when it comes to Medicare and VA benefits. Despite my attempt to simplify these benefits, every situation has its own unique requirements and there may be additional questions. That is why I recommend reaching out to a Medicare agent that has experience with VA benefits for assistance when it comes time to make decisions about Medicare and VA benefits.
Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or visit www.manormedisource.com today to stay on course with Medicare education and insurance solutions.FL License: W104335 CA License: 0I77441
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