Understanding how Medicare and VA benefits seamlessly combine to support your healthcare needs as a veteran can be a complex puzzle. You’re not alone if you’ve ever wondered about the interplay between these vital programs.
Navigating this territory requires expertise, and that’s where we step in. We’re here to explain the process, ensuring you make the best choices for your healthcare journey.
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 will 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 with 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 use the VA facility or civilian providers and facilities.
CHAMPVA covers the spouse, surviving spouse, children, or family members of a veteran with disabilities or who has passed away and is essentially a 75%/25% plan with a $50 deductible. You must enroll in Medicare Parts A and 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 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 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, you still have a few Medicare options but not TRICARE or CHAMPVA. This is the situation that most people are in and where the most confusion takes place.
If you plan never to use facilities other than VA, then taking Medicare Part B is not required. If you change your mind later, you would be assessed a Medicare Part B penalty for every year you were eligible for but did not enroll.
Medicare Part D is also optional, but you can add it later without a penalty. There are some cases in which the VA can only pay for your medical costs 100% outside of the VA facilities. Before deciding whether to add Medicare, you should speak to your benefits administrator to determine if you are in this situation.
Medicare and VA coverage
Next, we’ll discuss how the different coverage options work with Medicare Options.
Medicare and TRICARE
When you start your Medicare, TRICARE becomes secondary. Because Medicare and TRICARE cover differently, only your Medicare benefits will cover some healthcare services, and some will be paid only by your TRICARE benefits. Both Medicare and TRICARE will cover some health care benefits.
Original Medicare will be the primary insurance coverage and approve all of your healthcare services normally covered by Medicare and considered medically necessary.
If Medicare and Tricare cover a health care service and you have used up your Medicare benefit allowance, then TRICARE will become the primary payer for that service.
If this occurs, you must pay your TRICARE deductible, copayments, and coinsurances related to the service.
Remember that if you see a provider not participating with Medicare for a service covered by both insurances, Original Medicare won’t pay.
TRICARE would still pay as the secondary payer and pay the amount it would if a Medicare-approved healthcare provider provided it.
Some services are covered by Medicare but not by TRICARE. For example, chiropractic. In these cases, it would be the same as using Original Medicare.
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 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 must still pay your Part B and Part D monthly premiums if you enroll in a drug plan. This would make your Part D plan the primary payer and CHAMPVA you’re secondary. CHAMPVA will pick up some 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 to like them later, you may be assessed a late enrollment penalty.
If you don’t enroll in Medicare, you won’t be able to use your healthcare 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. If you decide not to enroll in a Part D plan, you could enroll in one later without penalty, unlike Medicare Part B.
Enrolling in a prescription drug plan coverage will make you 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 many plans with a zero-premium offer plenty of plan extras unavailable through VA benefits.
In addition to these plans, some pay a portion of your Medicare Part B, 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 if they do not want 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 not to 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.
The growing challenge of healthcare costs
Healthcare costs in the United States are rising, posing a significant challenge for seniors and veterans. Understanding the financial implications of healthcare is vital, especially when it comes to navigating the complex terrain of Medicare and VA benefits.
Statistics on average annual healthcare expenses
Recent data reveals the staggering truth about healthcare expenses. On average, Medicare beneficiaries face annual healthcare costs that have reached over $6,000 [Medicare.gov]. Veterans, who often require specialized care due to their unique healthcare needs, are also grappling with rising expenses. In fact, a Centers for Medicare and Medicaid Services survey found that 70% of veterans report substantial healthcare expenditure.
Why are these significant VA beneficiaries
The escalating healthcare costs underscore the importance of comprehending the intricacies of Medicare and VA benefits. Understanding how these benefits intersect becomes valuable and necessary as veterans and their families seek the best possible care. In the following sections, we will delve deeper into the intricacies of these programs and how they can work together to provide the healthcare support veterans rightfully deserve.
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. Remember that VA coverage is not considered creditable for Medicare Part B. 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 called Medicare Part C. They choose this sometimes as a no-cost backup plan. Others 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 learn 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 the VA doesn’t?
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 lifetime benefits 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 65 or under 65 with certain health conditions. This coverage is 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. It’s a per-occurrence deductible, and you pay it for each new hospital benefit period. The deductible is $1,632.
Getting help with VA coverage and Medicare
We know there is much to unpack when 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 who valiantly fought for our freedoms. If you want assistance getting the most out of your healthcare, give us a call or fill out our online request form. Thank you for your military service.