Can You Have Medicare And Va Insurance

Not Sure If You Should Sign Up For Medicare If You Get Va Benefits Even The Va Says It’s A Good Idea

If you qualify for both Veteran’s Affair and Medicare benefits, who pays for healthcare services can be confusing. Unlike other types of supplemental coverage, it isn’t a matter of who pays first between the VA and Medicare. Instead, it comes down to where you receive care. If it’s a VA facility, then your VA benefits pay. If it’s at a non-VA facility, Medicare pays assuming you go to a Medicare-approved provider.

Where Do I Access Medicare And Va Benefits

VA benefits cover services at VA-authorized or non-VA facilities with pre-authorization, whereas Medicare helps cover services at non-VA facilities.

You can access VA care at over 1,200 care locations across the United States, including:

• VA medical centers
• VA community living centers or other assisted living facilities

Consider factors such as budget, convenience and the type of care you need when deciding whether to go to a VA or non-VA facility. The chart below compares the advantages and disadvantages of the two.

VA Facilities vs. Non-VA Facilities

Check for VA-approved facilities near you to see if there is one you can conveniently access. If not, it could be worth signing up for Medicare to ensure you arent too far from a clinic in the event a health issue arises.

Is Medicare Part C Good For Veterans

Medicare Part C works like a private health insurance policy. You get all of your treatment from hospitals and doctors who accept Medicare, but your health plan is actually managed through a private health insurance company. You can get HMO, PPO or PFFS with Medicare Part C plans. Each company has these plans, but they are all of different costs. To choose the right one, you should pick a plan that allows you to see your own doctors but also pays for most out-of-pocket costs.

MedicarePartC.com, a website owned by Health Network Group, LLC, markets products underwritten by National Health Insurance Company, Integon National Insurance Company and Integon Indemnity Corporation. Health Network Group National Health Insurance Company, Integon National Insurance Company and Integon Indemnity Corporation are all related companies under National General Holdings Corp.

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Do Military Retirees Have To Pay For Medicare

Yes, military retirees have to pay for Medicare. Most people pay nothing for Part A, but if youre not eligible for premium-free Part A coverage, youll pay a premium that depends on how many quarters you worked and paid Medicare taxes. Youll also pay a deductible and coinsurance for services covered under Part A. For Medicare Part B, youll need to pay a monthly premium and a deductible for each benefit period. The Part B monthly premium is $170.10 for 2022 and yearly deductible is $233. You can expect to pay 20% coinsurance for most services covered under Part B. If you enroll in Part C or Part D, the premiums vary by plan.

You May Not Have The Same Va Coverage Forever

Another reason you may consider enrolling in Medicare is the possibility that you may lose your VA benefits at some point, leaving you without health insurance coverage.

VA health benefits depend on an annual appropriation of funds by Congress, and its unpredictable if enough funding will be approved in future years to care for all veterans. Those veterans in the lower priority groups are at particular risk to see a reduction or even a complete loss of their veterans benefits.

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Income Requirements For Virginia Medicaid

If you would like to be able to qualify for one of the Medicaid programs in Virginia, you will have to fall into the income bracket for the program you think you should be in. Pregnant women who might be in the FAMIS Plus program or Medicaid can make no more than 143% of the FPL as determined by the MAGI . For the childrens FAMIS program, MOMS, or Plan First, you cant earn more than 200% of the FPL. Children who are not yet 19 have to be in households that earn less than 143% of the FPL.

You can click here to find out more about the income limits for each household size.

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Should You Get Medigap If You Have Va Benefits

Perhaps. A Medicare Supplement Plan will fill in the unpaid gaps in coverage such as deductibles, copays, and coinsurance. Medicare also includes benefits when traveling outside of the U.S. and its territories.

Make sure to speak with your VA, Tricare, or CHAMPVA representative before enrolling in any supplemental plan to ensure that it is your best course of action. Here are two reasons why you may want to enroll in a Medigap plan:

It is important to enroll in Medigap when it is first available. If you apply outside of your Medigap initial enrollment period you will be asked medical questions. You could also be denied coverage or charged more.

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Combining Va Benefits Medicare And A Medigap Plan

Just because you have both VA benefits and Medicare doesnt mean all of your medical costs will be covered free-of-charge.

• In addition to the 2022 Medicare Part A deductible of $1,556 per benefit period, coinsurance for hospital stays lasting longer than 60 days starts at $389 per day in 2022.

• Moreover, after meeting your 2022 Part B deductible of $233 per year, you will likely be responsible for covering 20% of your medical costs.

A veteran may choose to supplement their Medicare coverage with a privately administered Medigap Insurance plan , which helps cover the out-of-pocket costs associated with Medicare, such as deductibles, copayments, coinsurance and other fees.

Whether or not VA benefits alone provide enough coverage will depend on the individual and his or her unique medical needs. It’s a good idea to speak to someone about your VA benefits to determine if you need a Medicare Supplement Insurance plan.

For more information about Medicare Supplement Insurance plans, call to speak with a licensed health insurance agent today.

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.

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How Veterans Can Make Sense Of Medicare And Va Benefits

by Christian Worstell | Published January 06, 2022 | Reviewed by John Krahnert

Veterans who receive health care benefits through the U.S. Department of Veterans Affairs can also enroll in Medicare upon turning 65.

Because each offers different benefits, having both at your disposal will broaden your health insurance coverage options.

If youre a veteran, its important to understand how VA benefits and Medicare work in tandem before you make the choice.

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.

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Va Health Care Eligibility

According to the Department of Veterans Affairs, You may be eligible for VA health care benefits if you served in the active military, naval, or air service and didnt receive a dishonorable discharge.

Those who enrolled in uniform services after September 7, 1980, or started active duty after October 16, 1981, must have served for two years or completed their active-duty period unless they meet certain exceptions, such as:

• Discharge due to an active duty-related disability
• Early discharge
• Serving before September 7, 1980

If you were or still are in the military reserves or National Guard, you can qualify for VA benefits if you completed your active-duty period as required by a federal order.

Eligible veterans can apply for VA benefits in one of five ways.

After submitting your application, youll receive a letter in less than a week stating whether your application was approved or not.

When You File Your Own Claim

Some disabled veterans dont live near VA hospitals. In this case, they may receive fee-based identification cards. They can present these for treatment at a health care facility or doctors office. Be sure to call ahead before accepting an appointment since not all providers accept these cards.

The process varies depending on the providers preferences:

• The provider can file the claim with the VA, and you only pay any applicable deductibles. You can also choose to use your Medicare benefits.
• You pay for the fees relating to the services you received, then submit your own claim to the VA. This option takes longer, but it might prove necessary if you cant get to a VA hospital.
• Use your Medicare benefits instead of your VA medical benefits. You might prefer this option if you dont have the money to pay up front for services rendered as described in the second option.

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Enroll In Medicare Part D At Myrxplanscom

There are a few instances in which enrolling in a Part D plan or a Medicare Advantage plan with prescription drug coverage may make sense:

• VA coverage includes its own drug formulary . If the VA does not cover a specific drug that you need to take, you might consider enrolling in a Medicare Part D plan that covers that drug.
• A drug prescribed by a doctor at a non-VA facility may not be covered by VA benefits without authorization.
• A non-VA pharmacy may be a more convenient way to obtain your drugs, especially if you reside in a nursing home or other long-term care facility.
• If you qualify for Medicare Extra Help, your overall drug costs may be lower with a Part D plan than under VA coverage.

Can A Veteran Get A Medicare Advantage Plan

Those who have both VA benefits and Medicare Part A and Part B have the option to enroll in a Medicare Advantage plan. Private insurance companies offer these plans. When you enroll in this coverage, the carrier you choose pays instead of Medicare.

The monthly costs for Medicare Advantage plans are relatively low. Sometimes, Medicare Advantage plans even come without premiums. Thus, Medicare Advantage plans are a good option for extra coverage when you already have VA benefits. In an emergency scenario where you would need care at a civilian facility, Medicare Advantage plans can help with costs.

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Are Veterans Required To Enroll In Medicare

Nobody is required to enroll in Medicare, but if you do so outside of your Initial Enrollment Period without from an employer, you could face late enrollment penalties. Its important to note that neither VA benefits nor TRICARE will qualify you to delay Medicare enrollment without financial penalty.

Q: Do I need Medicare if Im a veteran whos planning to work past 65?

A: If you have creditable drug coverage from an employer and plan to work past 65, you may be able to delay Medicare enrollment without penalty. .

Q: Is Medicare mandatory for veterans with VA benefits?

A: Medicare is not mandatory for anyone, but if you enroll outside of your Initial Enrollment Period and dont qualify to delay, you could face late enrollment penalties. If you have VA benefits, you do not have to enroll in Medicare in order to keep your VA benefits.

That being said, the Veterans Administration actually recommends veterans enroll in Medicare when they become eligible. Enrolling offers veterans more coverage choices and options for medical and hospital care, as well as for prescription drug services if they also enroll in a Part D plan. Finally, the VA has also cautioned veterans that its uncertain whether or not theyll be able to continue to cover all veterans in the future. Please click here to read the important statement from the VA about why you should sign up for Medicare at 65.

Q: Do you need to get Medicare when you have TRICARE?

Tricare For Life Plans And Medicare

Veterans who are eligible for Tricare and have Original Medicare can be automatically enrolled in Tricare for Life , a program that provides wrap-around Medicare coverage.

There arent any enrollment fees, but you generally need to keep Medicare Part B and pay the Part B premium in order to retain your TFL benefits.

If you have group health plan coverage from your employer, you should sign up for Medicare Part B during a special enrollment period in order to get TFL coverage when your group health plan coverage ends.

For services covered by both TFL and Medicare, you wont have any out-of-pocket costs, unless youve maxed out your Medicare benefits. In that case, youll have to pay the TFL deductible and cost shares.

For services covered by only one of the programs, you may have to pay the program deductible and a percentage of the costs.

Tricare is the secondary payer to Medicare if you access services at a Medicare-participating, non-participating or opt-out provider in the United States and U.S. territories, and the first payer elsewhere.

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How Should Veterans Receive Prescription Drug Coverage

The VAs prescription drug plan typically offers a more generous benefits package than Medicare Part D, the program’s prescription drug benefit. The VA covers the cost of drugs that you get at VA pharmacies, while Part D covers those that you get at in-network pharmacies.

The VAs drug plan is considered , meaning its as good or better than Medicares drug coverage, so veterans who later choose to enroll in Medicare Part D can do so without incurring a late enrollment penalty.

If you lose your VA benefits, youll have 63 days to enroll in a Part D plan before that penalty kicks in.

There are several reasons why a veteran would choose to supplement his or her VA drug plan with Medicare Part D:

• If you are prescribed a drug by a private clinician or a Medicare Part B-approved doctor, the VA will not cover the cost of that drug without additional authorization from a VA provider.

• If you enter a non-VA nursing home, you may want to get your drugs at the in-house pharmacy. A Part D plan could cover the cost of those drugs.

• If you live far away from a VA facility or are suddenly in need of medicine, you may find it easier or necessary to go to a non-VA pharmacy.

• If you have a low income, you may find that Medicares low-income subsidy program Extra Help for Part D beneficiaries will lower your overall drug costs.

You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.1

Should You Get Medicare Part B If You Have Va Benefits

Yes, it is strongly recommended that all veteran seniors enroll in Medicare Part B . There is typically a monthly fee for Part B but it is usually worth it.

If your VA Benefits are dropped at some point OR if your local VA facility does not cover all health services, you could pay 100% of the out-of-pocket expenses for a serious illness. The VA highly recommends that you enroll in Part B as well.

Dont miss the Part B deadline or you will have to pay a penalty. Check out our Medicare Deadline Calculator to see when you should sign up.

Please contact Veterans Affairs directly with questions about specific care at your local facility.

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