There Can Be Advantages To Having Both Types Of Coverage
There can be some definite advantages in having VA benefits and Medicare insurance.
- Having both types of coverage can give you more health care options. If you only have VA insurance, you are limited to receiving covered care at only VA facilities. But adding Medicare coverage can open up the range of hospitals, doctors offices, pharmacies and other types of health care locations in which you may receive covered care.
- Having both types of coverage can benefit you in the event that an emergency occurs when you are not in close proximity to a VA hospital.
- Most people do not have to pay a premium for Part A of Medicare.
You Might Be Subject To Late Enrollment Fees If You Forego Medicare Enrollment
If you do not sign up for Medicare Part B during your Initial Enrollment Period, you may be subject to late enrollment penalties if you decide to sign up later on.
The Part B late enrollment penalty is 10 percent of the Part B premium for each 12-month period in which you were eligible to enroll but did not. You will have to continue to pay the penalty for as long as you remain enrolled in Part B.
You may be able to avoid the Part B late enrollment penalty if you qualify for a Medicare Special Enrollment Period. Choosing not to enroll in Medicare Part B because you have VA coverage does not qualify you for a Special Enrollment Period.
Is Part B Needed
Medicare Part B is optional, but there are penalty fees for signing up after the initial enrollment period. Its important to note that Part B can help pay for care thats not covered by your VA benefits. So, while its not a requirement, it is good to enroll once you qualify.
If you are going to sign up for a Medicare Advantage plan or Medicare Supplement plan you need to have Medicare Part B in place first.
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Medicare And Veterans Administration Benefits Can Work Together
You can have both VA Benefits and Medicare. However, you will need to choose which benefits you use when you receive health care services or get health care items.
To use VA benefits, youll have to see a VA doctor or get care at a VA medical center or other VA location. The VA will also cover care if its been pre-authorized for services in a non-VA hospital or other care location.
If you go to a non-VA or also VA authorized care facility, Medicare may pay for the services you may need, or if the VA has only pre-authorized some services at the non-VA location, then Medicare may provide coverage for other services the VA doesnt cover. What Medicare does and doesnt cover will depend on the plan you have, what kind of health care facility you receive services at, and which benefits you designate to use if you can use both.
Do Veterans Have To Sign Up For Medicare
Medicare is not mandatory. However, there is significant value to signing up for this coverage when you become eligible.
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If you only have coverage through VA benefits, you may only receive care at a VA facility, unless otherwise approved. Often, approvals can take weeks or months to process. On the other hand, Medicare offers coverage in nearly every facility and from almost every provider throughout the nation.
Thus, having both Medicare and VA benefits allows individuals to access well-rounded health care coverage with a wide variety of eligible doctors and hospitals.
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Medicare Advantage And Veterans Benefits
If you are a veteran thinking of enrolling in a Medicare Advantage plan, your first question might be, âHow much more will it cost me?â The surprising answer is that enrolling may involve no additional cost to you, as many Medicare Advantage plans offer $0 premium packages. This is probably the strongest argument for joining a Medicare Advantage plan as a veteran. More coverage, more benefits, and more options for as little as $0/year.
Next, itâs important to understand that the VA system and Medicare have no overlap in benefits. To get VA benefits, you must use VA facilities, according to the official website of the U.S. Department of Veterans Affairs. This can be a big deal if your local VA hospital is far away. However, if you belong to a Medicare Advantage plan, you can use the local health care resources in your network.
Another reason why veterans should consider Medicare Advantage is that VA health coverage can change. According to the American Association of Retired Persons , health coverage with the VA varies from person to person and can change based on trends in federal funding or changes in VA priority groups. By enrolling in a Medicare Advantage plan, you can have peace of mind that you will always be covered.
The final thing to consider is Medicare Advantage supplemental benefits. With many Medicare Advantage plans, you become eligible for supplemental benefits that may not be covered by the VA, including hearing, dental, and vision services.
Yes You Can Have Both Medicare And Va Benefits
In fact, the Veterans Administration encourages eligible veterans to sign up for Medicare.1 And if you opt for a Medicare Advantage plan, you may enjoy valuable additional benefits like dental, vision and hearing careeven prescription drug coveragewith a low or, in some areas, a $0 monthly plan premium.
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What Is The Va Dental Insurance Program For Veterans And Survivors And Dependents Of Veterans
The VA Dental Insurance Program is a pilot program that provides premium-based dental insurance coverage through which eligible individuals may choose to obtain dental insurance from a participating insurer.32
The Caregivers and Veterans Omnibus Health Services Act of 2010 ” rel=”nofollow”> P.L. 111-163) authorized the VHA to conduct a three-year pilot program to assess the feasibility and advisability of providing private, premium-based dental insurance coverage to eligible veterans and certain survivors and dependents.33Generally, survivors and dependents that would qualify for the program will be Civilian Health and Medical Program of the VA beneficiaries. Under the three-year pilot program , the VHA contracted with qualified dental insurance carriers that provide dental insurance and administer all aspects of the dental insurance plan. The VHA administers the contract with the private insurer and verifies eligibility of veterans, survivors, and dependents.34
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If you receive care at a VA facility, it will be covered by your VA insurance. If you have Medicare and receive Medicare-approved care at a non-VA facility, Medicare will provide coverage.Medicare will not provide coverage at a VA facility, and VA benefits will not provide coverage at a non-VA facility.
In other words, you must visit a VA hospital or medical facility in order to use your VA coverage, and you must visit a civilian hospital or medical facility in order to use your Medicare coverage.
VA benefits and Medicare coverage do not overlap.
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Medicare And Va Benefits
There are several insurance programs available to those who are also eligible for Medicare. The most popular of these programs include FEHB for federal employees and TRICARE for those serving in the military and their families.
When it comes to VA benefits and Medicare, understanding who pays for the services you receive is simple. You use VA benefits when receiving care at a VA hospital or facility. Yet, when the facility where your services take place is Medicare-certified, Medicare will pay. In some instances, non-VA facilities may authorize VA coverage. In this case, Medicare would pay for any Medicare-covered services that VA benefits do not pay for.
Keep in mind, Medicare does not pay for care received at a VA facility. Likewise, VA benefits do not pay secondary to Medicare. This means VA benefits will not cover any Medicare cost-sharing expenses.
When Should You Enroll In Medicare
You should enroll in Medicare as soon as possible after you become eligible. Depending on when you enroll, there could be a significant gap before your coverage goes into effect, and you may be subject to late enrollment fees. Enrolling as soon as possible after you become eligible ensures you have Medicare coverage in place should you need it. If you wait to enroll and need medical care before your Medicare coverage begins, youll have to use your VA benefits, which could prevent you from going to a non-VA facility.
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Do I Need To Sign Up For Medicare If Im A Veteran With Va Health Care
En español | You arent required to sign up for Medicare if you have health care coverage through the U.S. Department of Veterans Affairs , but the VA encourages veterans to sign up for Medicare Part A and Part B during their initial enrollment period at 65, unless they also have group insurance from a current employer.
That way, youll have more options for care. VA health benefits provide coverage for care in VA clinics and hospitals but they generally dont cover other facilities and doctors.
Even if youre happy with your VA health care benefits now, your medical needs or the VA health systems costs and coverage could change. And you could end up with a late-enrollment penalty if you decide to sign up later for Medicare.
How Tfl And Medicare Coordinate
If you have Medicare and TFL, Medicare is the primary insurer and TFL is the secondary insurer for services covered by both plans. For example, after a Medicare-covered doctors visit, Medicare would pay 80% of the Medicare-approved amount and TFL would pay the remaining 20%, up to its allowable charge.
If you have other supplemental health insurance in addition to Medicare and TFL, Medicare pays first, followed by your other insurance and then by TFL. For example, after a Medicare-covered doctors visit, Medicare would pay first and your other health insurance would pay second. If there was still a balance you wanted TFL to pay, you would need to file a claim with the TFL contractor online or by phone at 1-866-773-0404 or 1-866-773-0405 . Note: The TFL contractor covering California is Wisconsin Physicians Services, Inc.
For services covered by TFL but not Medicare , TFL is the primary payer and you are responsible for the TFL standard annual deductible and cost sharing, unless you have other health insurance.
For services covered by Medicare but not TFL, Medicare is the primary payer. If there is a balance after Medicare pays, you are responsible for it unless you have other supplemental health insurance. TFL will not cover any part of these services.
For services not covered by TFL or Medicare, you are responsible for the cost, unless you have health insurance that covers these services.
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Is Enrollment Different For Returning Combat Veterans
Veterans returning from combat operations are eligible to enroll in VA health care for five years from the date of their most recent discharge without having to demonstrate a service-connected disability or satisfy an income requirement. Veterans who enroll under this extended enrollment authority continue to be enrolled even after the five-year eligibility period ends.
This special period of enrollment eligibility for VA health care was first established in 1998 and was expanded in 2007. In 1998, Congress, responding to the growing concerns of Persian Gulf War veterans’ undiagnosed illnesses, passed the Veterans Programs Enhancement Act of 1998 ” rel=”nofollow”> P.L. 105-368), entitling a veteran who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War to be eligible to enroll in VA health care during a two-year period following the date of discharge.
If I Have Va Drug Coverage Do I Need Medicare Part D
You arent required to buy Medicare Part D prescription drug coverage if you have VA health benefits. The prescription drug benefits from the VA are considered to be as good as or better than Medicare Part D, which the Centers for Medicare & Medicaid Services calls creditable coverage, so you wont have to pay a penalty if you decide to sign up for Part D later.
But VA health care only covers VA providers and pharmacies. Some people sign up for Part D too, so they can also get prescriptions from doctors outside the VA and fill them at a nearby pharmacy.
Also, a Part D plan may cover different drugs than the VA and charge different copayments. VA copays for prescription drugs can vary by priority level. You cannot use your VA and Part D benefits for the same expenses.
If you have VA drug benefits, you can sign up for a Part D plan without paying a late-enrollment penalty any time after you enroll in Medicare Part A or Part B or within 63 days of losing VA drug benefits.
Keep in mind
Medicare has premiums, deductibles, copayments and other out-of-pocket costs. If your income and assets fall below certain levels, you may qualify for help with some of these expenses from a Medicare Savings Program. You also may be eligible for help with Medicare Part D premiums and copayments from the Extra Help financial assistance program .
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What Are The Advantages Of Having A Medicare Plan With Va Benefits
Here are a few reasons why we recommend having some form of Medicare in conjunction with your VA health coverage:
- VA healthcare funding is not guaranteed. Thus, future budget cuts could prevent some veterans from getting benefits through the Department of Veterans Affairs.
- Medicare coverage allows you to receive care at non-VA hospitals. This is vital, as VA hospitals are known for having long lines and poor service.
- If you dont want Medicare now, you may have to pay a late enrollment penalty for signing up later on.
- Medicare Part D makes it easier to get prescription drugs from local pharmacies, as opposed to the VAs mail-order system.
In short, Medicare helps give you more options and, in many cases, higher-quality care than the VA health system. By relying on VA healthcare, you could be putting yourself at risk if you need care from a non-VA clinic. Finally, Medicare is well-funded and unlikely to suffer from budget cuts anytime soon.
Should You Get A Medicare Advantage Plan If You Have Va Benefits
Probably.Medicare Advantage plans can help reduce your out-of-pocket risk should you go to a non-VA facility. Many MA plans have no little or no additional cost.
If you go down this path we recommend that you look for a zero premium policy. Be sure to select one that doesnt include prescription drugs since you most likely get those through the VA. We can help you enroll in a no-cost Medicare Advantage plan at 800-930-7956.
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Do I Have To Pay For Medicare If I Have Va Benefits
No, you do not have to pay for Medicare Part A or B. If you qualify for premium-free Part A, you can choose to forego Part B . Alternatively, you can choose to use your VA benefits and not enroll in Medicare at all. However, this means that you will be limited to VA hospitals and doctors. This is why we recommend enrolling in Medicare so that you have access to non-VA care.
But The Va Offers Everything I Need Do I Really Need To Pay More For Part B
Its the smart move, for sure. If you dont sign up for Part B when you turn 65 and you decide you actually do want it after all at some point later, youll pay a penalty for it at that time. Its hard for you to know now what health services youll need in the future and you may well find that the VA doesnt provide everything you need. Part B allows you to seek out services elsewhere instead of relying on the VA exclusively.
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Do I Need Medicare If I Have Veterans Benefits
Home / FAQs / General Medicare / Do I Need Medicare if I Have Veterans Benefits?
For veterans approaching Medicare eligibility, it is common to have questions about whether it is necessary to enroll in Medicare alongside Veterans Affairs benefits. The short answer is that Medicare does not coordinate with VA benefits. However, you can have both types of insurance at the same time and benefit from doing so. Below, we answer the most frequently asked questions about Medicare for veterans.
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Do I Need Part D If I Have Va Benefits
VA benefits include prescription drug coverage. Unlike VA health coverage, VA drug coverage is creditable for Medicare Part D. This means if you delay Medicare Part D coverage due to VA drug coverage, you will not be responsible for the Medicare Part D penalty in the future.
However, most beneficiaries with both Medicare and VA benefits do not need to enroll in prescription drug coverage through a Medicare Part D plan. If there comes a time when you choose to cancel your VA coverage, you will want to pick up a Medicare Part D plan as soon as possible.
Additionally, there are some situations in which an individual with Medicare and VA benefits could benefit from signing up for Medicare Part D. These circumstances include residing in an area where VA facilities are inaccessible or wanting more options for pharmacies at which to pick up prescriptions.
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For individuals who struggle to pay for their prescriptions, a Medicare Part D plan could also be a good option. If you qualify for Medicare Part D Extra Help, your prescriptions may have lower copays than they would through VA benefits.
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