While Medicare covers the majority of people aged 65 and over, if you are a veteran (or a family member of a veteran), you might be eligible for additional health care benefits that supplement Medicare. You could already have health-care coverage through VA Benefits, TRICARE (administered by the Department of Defense), or CHAMPVA (administered by the Department of Veterans Affairs Chief Business Office Purchased Care), so Medicare can work through these services in a variety of ways.
This article will walk you through the process of combining Medicare with your current veteran health care options.
If you're qualifying at 65, it's always a good idea to join Medicare Part A and Medicare Part B because it includes inpatient hospitalizations, hospice, skilled nursing services, and outpatient care from non-VA providers. Enrolling now will help you avoid coverage gaps and avoid late enrollment fines if you opt to enter Medicare later. Part A is usually free for most people, while Part B needs a monthly fee.
However, you must be enrolled in Original Medicare before enrolling in TRICARE For Life (Parts A & B).
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Veterans typically use the VA prescription drug benefits instead of Medicare Part D because the VA prescription drug benefits have lower out-of-pocket costs. Anyone enrolled in Medicare Part A and/or B, on the other hand, will enroll in Medicare Part D. If any of the following circumstances apply to you, you may want to suggest joining:
You fill prescriptions written by non-VA doctors at a nearby discount pharmacy.
You are eligible for Medicare's Extra Help Program, which means your Part D prescription copayments are lower than your VA copayments.
The prescriptions aren't on the VA's list of covered medications, also known as a "formulary."
Due to the fact that VA and TRICARE coverage is creditable, there are no late enrollment fees if you enter Part D later.
If you qualify for both Medicare and VA benefits, you will receive treatment in either program. Each time you receive health care, you must choose which method to use. Medicare can only pay for services provided by hospitals that have been approved by Medicare. You must either go to a VA facility or have the VA approve facilities in a non-VA facility to get the VA to pay for them. If the VA authorizes treatment in a non-VA hospital but does not pay for all of the services you receive, Medicare will cover a portion of the Medicare-covered services.
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Since VA and Medicare benefits rarely overlap, veterans with VA benefits are encouraged to participate in Medicare Parts A and B. Services received at VA facilities are not covered by Medicare, and the VA will not pay for services provided by non-VA providers (doctors and hospitals). Veterans who want non-VA treatment or care should enroll in Medicare Parts A and B.
It's important to remember that not all veterans are qualified for the same amount of VA assistance. According to congressional appropriations, VA priorities will move, and veterans with lower-level priorities will see adjustments (possibly reductions) in their benefits over time. If a veteran loses their VA coverage and enrolls in Medicare Parts A and B, the 10% late enrollment penalties for Parts A and B will apply for each year of delay.
Contact the Department of Veterans Affairs to learn more about your VA benefits and Medicare enrollment options. Take our Medicare Questionnaire assessment to get free certified Medicare guidance from a licensed benefits adviser if you need support choosing a Medicare plan that works with your Veterans benefits.
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