It seems there is more wrong information given to our veterans as they approach 65 than any other group. This is due to a lack of understanding that people have when trying to tie the governmental VA system to Medicare.
Hopefully, by the end of this article, there will be a more precise understanding of how these two coverages can work together to provide the best health insurance for your situation.
Veterans Affairs Benefits and Medicare
With Veterans Affairs Benefits there are several options that you may have. Some require all parts of Medicare to continue with the coverage and some don’t.
We’re going to discuss what happens once you become Medicare-eligible and the different parts of Medicare coverage. Then what’s needed, recommended, and what’s optional.
Types of VA Health Care
Once you retire as a veteran and turn 65 eligible veterans generally have a form of Tricare, CHAMPVA, or Standard VA benefits. Below we’ll describe each one.
TRICARE for Life
Tricare becomes Tricare For Life upon turning 65 and starting Medicare. TFL is a wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Parts A and B.
You must enroll in Medicare Parts A and B and continue paying for your Medicare Part B premium for TRICARE for life. Beneficiaries with TFL have prescription drug coverage through TRICARE. They aren’t required to enroll in Medicare Part D.
They can enroll in a Medicare Part D Drug plan or Medicare Advantage plan if they choose. However, enrolling in a Medicare Advantage plan isn’t recommended as it could cause coverage coordination issues.
Individuals with TRICARE for LIFE can choose to either use the VA facility or civilian providers and facilities.
CHAMPVA is coverage for the spouse, surviving spouse, children, or family members of a veteran with disabilities, or a veteran that has passed away. CHAMPVA is essentially a 75%/25% plan with a $50 deductible. You must enroll in Medicare Parts A and Medicare Part B similar to TRICARE. Also like TRICARE Part D is optional.
Once you begin Medicare it becomes primary, and CHAMPVA becomes secondary. You can use CHAMPVA in conjunction with Medicare, Medicare Advantage, and Medicare Part D.
If you turned 65 and did not have Medicare Part B as of June 5, 2001, you can keep CHAMPVA without enrolling in Medicare Part B. In this case, you’ll need to use VA facilities for your health care.
For anyone else, you must enroll and maintain both Medicare Part A and Medicare Part B to remain enrolled in CHAMPVA. Once enrolled in Medicare you can no longer use VA facilities or providers.
If you qualify for VA benefits but not TRICARE or CHMPVA you still have a few Medicare options. This is the situation that most people are in, and where the most confusion takes place.
If you plan to never use facilities other than VA facilities, then taking Medicare Part B is not required. Keep in mind if you change your mind later you would be assessed a Medicare Part B penalty for every year that you were eligible for but did not enroll.
Medicare Part D is optional as well, but you can add it later without a penalty. There are some cases in which the VA only can pay for your medical costs 100% outside of the VA facilities, You should speak to your benefits administrator to find out if you are in this situation before you decide on whether to add Medicare.
Medicare and VA Coverage
Next, we’ll discuss how the different coverage options work in conjunction with Medicare Options.
Medicare and TRICARE
When you start your Medicare Tricare becomes secondary. Because Medicare and TRICARE cover differently some healthcare services will be covered by only your Medicare benefits, and some will be paid only by your TRICARE benefits. Some health care benefits will be covered by both Medicare and TRICARE.
Original Medicare will be the primary insurance coverage and will approve all of your healthcare services that are normally covered by Medicare and considered medically necessary.
If a health care service is covered by both Medicare and Tricare and you have used up your Medicare benefit allowance, then TRICARE will take over and become the primary payer for that service.
In the case this occurs, you must pay your TRICARE deductible, copayments, and coinsurances related to the service.
If you see a provider that doesn’t participate with Medicare for a service that is covered by both insurances, Original Medicare won’t pay for the service.
TRICARE would still pay as the secondary payer and pay the amount it would if it was provided by a Medicare-approved healthcare provider.
There are some services that are covered by Medicare, but not by TRICARE. For example chiropractic. In these cases, it would be the same as using Original Medicare only.
Likewise, if you are receiving services covered by TRICARE and not Medicare. For example overseas healthcare. Then the service would be covered as if you have TRICARE only
Medicare Advantage and Tricare
You can choose to have a Medicare Advantage or Supplemental insurance with TRICARE, however, most will not choose to as the coverage can be redundant. Many will look into Medicare Advantage for the plan extras.
The concern is it could cause coordination of coverage benefit issues between TRICARE and Medicare Advantage. Medicare Supplement insurance does the same thing that TRICARE does for Medicare so it is redundant to have both.
Medicare and CHAMPVA
Upon turning 65 and enrolling in MEDICARE, the primary payer will be Medicare. You can still get your prescriptions from CHAMPVA
Original Medicare, Medicare Part D, and CHAMPVA
You’re still required to pay your Part B and Part D monthly premium if you enroll in a drug plan. This would make your Part D plan the primary payer and CHAMPVA you’re secondary. CHAMPVA will then pick up some of all of your copays and coinsurance amounts left over from Medicare.
Medicare Advantage and CHAMPVA
If your Medicare Advantage plan has a premium you would be responsible for the premium. The Medicare Advantage plan would become the primary coverage for health care services and prescriptions.
CHAMPVA would pick up your coinsurance, and copayments as long as the provider is in-network for your Medicare Advantage plan.
Medicare and VA Benefits
Here is where there ends up being a lot of misunderstandings.
Original Medicare and VA Benefits
You are not required to enroll or stay enrolled in Medicare if you have VA benefits only. However, if you decide later you would like them you may be assessed a late enrollment penalty.
In many cases, if you don’t enroll in Medicare, you won’t be able to use your health care coverage outside of VA Hospitals, facilities, and providers.
If you enroll in Medicare Part A and Medicare Part B you’ll be able to use your Medicare for non-VA facilities, hospitals, and providers.
Original Medicare, Part D, and VA Benefits
VA drug coverage is considered creditable coverage for Medicare Part D. This means if you decide not to enroll in a Part D plan, you could enroll in one at a later date without penalty, unlike Medicare Part B.
If you enroll in a prescription drug plan coverage, you’ll be responsible for your Part D Premium. You could use your Veterans Benefits coverage to pick up your prescriptions from VA facilities, and your Medicare Part D plan for civilian pharmacies.
Medicare Advantage and VA Benefits
Medicare Advantage plans are great options for veterans with VA benefits only. This is because there are many plans with a zero-premium that gives plenty of plan extras not available through VA benefits.
In addition to these plans, there are some that pay a portion of your Medicare Part B, and that are specifically designed for veterans.
If you choose to enroll in a Medicare Advantage plan you must be enrolled in Medicare Parts A and B. You would use your VA coverage at VA facilities, and use your Medicare Advantage plan at non-VA facilities and non-VA hospitals
Medicare Supplement and VA Benefits
Most VA members use their Medicare plans as backup coverage in case they are not wanting to use VA facilities. However, some prefer civilian doctors to VA providers.
In this case, they can enroll in a Medigap plan to use with their Medicare. They keep their VA just in case they want to use the VA facilities but have enough coverage to not have to do so if they choose.
Many VA beneficiaries will choose a high deductible supplement if they want the peace of mind of being able to see a doctor if they can’t get to the VA.
Are VA benefits primary over Medicare?
No! If you have CHAMPVA or TRICARE, Medicare becomes primary. For VA only, Your VA will pay at VA facilities, and Medicare will pay at non-VA facilities that accept Medicare.
Do you need Medicare Part B if you have VA benefits?
You need to enroll in Medicare If you have TRICARE or CHAMPVA. If you have VA benefits only Part B is optional. Keep in mind VA coverage is not considered creditable coverage for Medicare Part B. This means if you change your mind later and want to enroll, You’ll be assessed a penalty.
Can you have Medicare Advantage and VA benefits?
Yes! Many beneficiaries with VA benefits choose a Medicare Advantage plan sometimes referred to as Medicare Part C. They choose this sometimes as a no-cost backup plan. Others choose to enroll in a Medicare Advantage to receive additional benefits they don’t get with VA or Medicare.
How does Medicare work with VA benefits?
If you have TRICARE or CHAMPVA, your Medicare is primary and your government coverage is secondary. With the VA they work separately. VA is used in VA facilities, and Medicare is used in non-VA facilities. Of course, there are exceptions. You should speak to your VA benefits administrator for any exceptions.
How can I find out which benefits I have?
The best way to find out information about your VA health benefits is to contact your U.S. Department of Veterans Affairs benefits administrator for VA, TRICARE, or CHAMPVA.
What does Medicare cover that VA does not?
Medicare covers civilian healthcare providers and facilities. VA covers VA hospitals, providers, and facilities.
What is the VA home loan program?
The VA home loan program helps our veterans buy homes. Some main benefits include no downpayment, low-interest rates, no need for Private Mortgage Insurance, and it’s a lifetime benefit that can be used multiple times.
What happens if you have Medicare and VA benefits?
It will depend on which VA program you’re in.
With TRICARE and CHAMPVA combined with Medicare, your VA coverage will work alongside your Medicare like a Medicare Supplement. If you are on VA only and Medicare you’ll use Medicare for healthcare providers, services, and hospitals in civilian settings. You would use your VA coverage at VA facilities, hospitals, and providers.
What are the differences between Medicare and VA benefits?
Medicare is coverage from the federal government for civilian Americans over the age of 65, or under 65 with certain health conditions. This coverage is used for non-VA doctors, facilities, and hospitals. VA is coverage for ex-military to be used VA facilities.
Is there a limit to the number of years that you can receive VA benefits?
No there is not typically a limit of years for your VA benefits.
What is the Medicare Part A deductible?
The Medicare Part A deductible is for the hospital portion of Medicare. The deductible is applied on a per-occurrence basis. In 2022, the deductible about is $1,556
Getting Help with VA Coverage and Medicare
We know there is a lot to unpack when it comes to combining your government coverage with Medicare. Fortunately, there is help. Our licensed agents are well versed and specialize in Medicare. They can help evaluate your situation, and help you make the best decision for your needs.
We’d love to help you with your healthcare needs and give back to our heroes that valiantly fought for our freedoms. If you would like assistance in getting the most out of your healthcare, give us a call, or fill out our online request form. Thank you for your military service.