If You Have Or Can Get Both Medicare And Veterans’ Benefits You Can Get Treatment Under Either Program
If you have or can get both Medicare and Veterans benefits, you can get treatment under either program. Generally, Medicare and VA cant pay for the same service or items. Medicare pays for Medicare-covered services or items. Veterans Affairs pays for VA-authorized services or items.
When you get health care, you must choose which benefits to use each time you see a doctor or get health care.
To get the U.S. Department of Veterans Affairs to pay for services, you must go to a VA facility or have the VA authorize services in a non-VA facility.
If the VA authorizes services in a non-VA hospital, but didnt authorize all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered services the VA didnt authorize.
For active-duty military enrolled in Medicare, TRICARE pays for Medicare-covered services or items, and Medicare pays second
For inactive-duty military, Medicare pays first for Medicare-covered services and TRICARE may pay second.
TRICARE pays first for services or items from a military hospital or any other federal provider
Get more information on TRICARE.
Everyone Affected By The Covid
Announcing “a new plan to require more Americans to be vaccinated to combat those blocking public health,” Biden on Sept. 9 rolled out his administration’s Path Out of the Pandemic program, which aims to increase the vaccination rate by requiring shots across public and private sectors.
Here’s who would be required to be vaccinated under the plan:
- Employers with 100 or more employees will be required to have their employees either be fully vaccinated or get tested weekly to come to work . Biden said the Department of Labor’s Occupational Safety and Health Administration would implement the requirements that will affect 84 million workers.
- Federal workers and employees of contractors that do business with the federal government will be required to be vaccinated, though they won’t be penalized for not getting the vaccine until January 2022. for them to get the vaccine.
- The Department of Health and Human Services will require vaccinations in Head Start programs, as well as schools run by the Department of Defense and the Bureau of Indian Education.
- Workers in health care facilities that receive Medicare and Medicaid reimbursements, including hospitals and home health agencies, will also have to be fully vaccinated.
- Individuals applying to become lawful permanent US residents must be fully vaccinated, US Citizenship and Immigration Services said.
How Is Medigap Different From Medicare Advantage
Medigap supplements Original Medicare, while Medicare Advantage is an alternative to Original Medicare. Medigap does not significantly expand the range of services that are covered by Medicare instead, it reduces your out-of-pocket costs for using those covered services. Medicare Advantage plans usually have a wider set of covered services relative to Original Medicare, but you are still responsible for copays and coinsurance as outlined in your policy. When you have Original Medicare and Medigap, you can receive care from any health provider that accepts Medicare. On the other hand, Medicare Advantage plans generally restrict you to healthcare providers within a network.
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Additional Vaccines That Are Mandated In The Us
A federal vaccine mandate is not new. In 1977, for example, the federal government began an initiative to vaccinate up to 90% of the nation’s children against seven diseases:
All 50 states require specific vaccines for students, with exemptions varying from state to state. Most school requirements follow the CDC’s vaccine schedule for children.
Is Medicare Primary Or Secondary To Employer Insurance
When you receive medical services, your primary insurance pays out first. This insurance is known as the primary payer.
If theres anything that your primary insurance didnt cover, your secondary insurance pays out next. This insurance is known as the secondary payer. The secondary payer generally covers some, if not all, of the remaining costs.
Heres how to know who the primary and secondary payers are in your situation:
- Medicare is generally the primary payer if the company you work for has fewer than 20 employees. But Medicare becomes the secondary payer if your employer is part of a group health plan with other employers who have more than 20 employees.
- Medicare is typically the secondary payer if the company you work for has 20 or more employees. In this case, your group health plan is the primary payer and Medicare pays out only after your employers plan has paid their portion.
The rules above are for general circumstances and may change depending on your specific situation. If youre not sure whether Medicare will be the primary or secondary payer in your situation, you can call 855-798-2627 to speak to someone at Medicares Benefits Coordination & Recovery Center.
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What Is Original Medicare
Original Medicare is a federally subsidized program managed by the government with the purpose of granting health insurance coverage to those that are eligible. In order to be eligible for Medicare, you must be:
Once becoming eligible for the program, you will be able to enroll and gain access to the services of both Medicare Part A and Part B. Both of these parts encompass the different health care services provided to enrollees with the goal of ensuring basic coverage.
What Are Medicareadvantage Plans
MedicareAdvantage plans are private managed care plans that provide the standard Medicare benefits plus additional supplemental benefits for a monthly fee. These plans may include prescription drug coverage, even after January 1, 2006, if the benefits are similar to the new Medicare benefit. MedicareAdvantage participants may even receive a subsidy for their prescription drug benefits in most cases.
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Who’s Opposed To The Mandate
Since the White House announced federal COVID-19 vaccine mandates affecting roughly two-thirds of the US workforce, or up to 100 million people, it has received a backlash from congressional Republicans, as well as state and local officials.
Republican governors have threatened to fight the administration’s new policies. Washington Rep. Cathy McMorris Rodgers, the senior Republican on the House of Representatives committee overseeing health policy, said Biden “is using fear, control and mandates.” The Republican National Committee has vowed to sue the Biden administration over the vaccine mandate.
Ten states — Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire — challenged the vaccine mandate for health care workers.
A report from the Centers for Disease Control and Prevention on Sept. 17 shows that unvaccinated people were over 10 times more likely to become hospitalized or die from COVID-19, according to data from April through July: “Getting vaccinated protects against severe illness from COVID-19, including the delta variant.”
Some companies that fall under the new vaccine mandate are facing challenges and questions about compliance and implementation of the policy, according to The Wall Street Journal. For example, businesses have to figure out who will be responsible for covering the cost of testing unvaccinated employees and whether they can authorize exemptions.
Looking For Help With More Than Costs
Original Medicare doesnt cover things like prescription drugs, dental services, vision and hearing. To get prescription drug coverage, you need to purchase a Medicare Part D plan. Part D plans are sold by private insurance companies. Theyre specifically designed to help pay the cost of prescription medications. Learn more about Medicare Part D here. An additional way to get drug coverage is to purchase another part of Medicare, called a Medicare Advantage plan. Medicare Advantage plans are sold by private insurance companies and are also known as Medicare Part C.
Medicare Advantage plans often include additional coverage, like dental, vision and hearing. There are some important similarities and differences between Medicare Supplement plans and Medicare Advantage plans.
While both are provided by private insurance companies, there are some key differences between Medicare Supplement plans and Medicare Advantage plans:
- Medicare Advantage plans often provide prescription drug coverage. Medicare Supplement plans dont.
- Medicare Supplement plans work together with Parts A and B. Medicare Advantage plans include all the benefits of Part A and B but you work with a private company, not the federal government.
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What You Need To Know About Medicare Parts A B C And D
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There are four parts of Medicare: Part A, Part B, Part C, and Part D. In general, the four Medicare parts cover different services, so it’s essential that you understand the options so you can pick your Medicare coverage carefully.
Improvements To Medicare’s Preventative Care Coverage
Medicare beneficiaries pay nothing for most preventive services if the services are received from a doctor or other health care provider who participates with Medicare . For some preventive services, the Medicare beneficiary pays nothing for the service, but may have to pay coinsurance for the office visit to receive these services.
Medicare covers two types of physical exams one when you’re new to Medicare and one each year after that. The Welcome to Medicare physical exam is a one-time review of your health, education and counseling about preventive services, and referrals for other care if needed. Medicare will cover this exam if you get it within the first 12 months of enrolling in Part B. You will pay nothing for the exam if the doctor accepts assignment. When you make your appointment, let your doctor’s office know that you would like to schedule your Welcome to Medicare physical exam. Keep in mind, you don’t need to get the Welcome to Medicare physical exam before getting a yearly Wellness exam. If you have had Medicare Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. Again, you will pay nothing for this exam if the doctor accepts assignment. This exam is covered once every 12 months.
Supplemental Coverage Among Beneficiaries With Basic Medicare
|No supplemental coverage||19%|
In that situation, unless you have some type of employer-sponsored insurance or you get extra coverage from Medicaid, the option for mitigating your out-of-pocket costs is a Medigap policy.
Those supplemental policies, which are sold by private insurance companies, either fully or partially cover cost-sharing aspects of Parts A and B, including deductibles, copays and coinsurance. They also limit what you’ll pay out of pocket each year.
Yet about 19%, or 6.1 million, who stick with basic Medicare have no extra coverage, according to a 2018 study from the Henry J. Kaiser Family Foundation.
That’s risky, experts say. While Part A is free for most beneficiaries, it comes with a $1,364 deductible per benefit period. And although Part B comes with a low $185 per-year deductible, you typically pay 20% of the remainder for most doctor services including while you’re a hospital inpatient as well as outpatient therapy and durable medical equipment such as wheelchairs or walkers.
“That 20% is after your deductible, and there’s no limit to how much you’d pay out of pocket,” said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.
“If you have a heart attack, need multiple surgeries and hospital visits, you could literally end up bankrupt,” she said.
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Finding Part D Drug Insurance
To get started, find the plans available in your zip code. Once you have created an account at Medicare.gov, you can enter the names of your drugs and use a convenient tool that allows you to compare plan premiums, deductibles, and Medicare star ratings .
If you dont take many prescription drugs, look for a plan with a low monthly premium. All plans must still cover most drugs used by people with Medicare. If, on the other hand, you have high prescription drug costs, check into plans that cover your drugs in the donut hole, the coverage gap period that kicks in after you and the plan have spent $4,430 on covered drugs in 2022.
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Many Cities States And Universities Already Have Vaccine Mandates
Several states, including California and New York, require state employees to be vaccinated. Additionally, several cities, like New York City and San Francisco, require proof of vaccination for inside dining, gyms and other indoor activities. There’s a mandate that applies to all city workers in New York City and comes with a $500 bonus for getting vaccinated.
Los Angeles County requires proof of vaccination to enter indoor bars, nightclubs, breweries and wineries. Los Angeles also approved its strictest COVID-19 vaccination mandate, which requires people age 12 and older to be fully vaccinated before entering public indoor places. Also in California, a judge ordered vaccine mandates for prison guards and staff.
California Gov. Gavin Newsom says all students, elementary through high school, will be required to get the shot. Nine states, as well as the District of Columbia and Puerto Rico, have vaccination requirements for staff in K-12 schools.
More than 400 colleges and universities are also requiring vaccines for students who plan to take in-person classes.
A Pfizer injection at a mass vaccination site in March at the Circuit of the Americas racetrack in Austin, Texas.
Services Not Covered By Medicare Or Medigap
When planning your retirement, its important to remember that Medicare policies do not cover all services you may need in the future. Services excluded by Medicare are:
- Long-term care
- Most dental care
- Eye examinations related to prescribing glasses
- Hearing aids and exams for fitting them
- Routine foot care
If you see the need for these services in the future, it may be worthwhile to consider purchasing additional private health insurance or looking for a way to remain on your employers insurance after retirement . The amount of information and options for medical insurance can be overwhelming, so dont hesitate to work with a trusted insurance agent, family member, or doctor to help consider your needs and benefits.
You can also find a phone number for your own State Health Insurance Assistance Program an organization set up specifically to provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers by selecting your state from the drop down menu here.
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Can I Get My Health Care From Any Doctor Other Health Care Provider Or Hospital
- Original Medicare
You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.
In most cases, you don’t need a
to see a specialist.
- Medicare Advantage
In many cases, youll need to only use doctors and other providers who are in the plans network . Some plans offer non-emergency coverage out of network, but typically at a higher cost.
You may need to get a
You can join a separate Medicare drug plan to get Medicare drug coverage.
- Medicare Advantage
Medicare drug coverage is included in most plans. In most types of Medicare Advantage Plans, you cant join a separate Medicare drug plan. You can join a separate Medicare drug plan with certain types of plans that:
- Cant offer drug coverage
- Choose not to offer drug coverage
Youll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:
What Other Types Of Coverage Can You Have With Medicare
There are several different situations when you may have private insurance and Medicare at the same time. This can happen if you have:
- Coverage through an employer. Its possible that youll still have private insurance through your employer when youre eligible for Medicare.
- Coverage under your spouses private health insurance. You can have Medicare and also be covered on a group plan provided by your spouses employer.
- COBRA.COBRA allows you to temporarily keep private insurance coverage after your employment ends. Youll also keep your coverage if youre on your spouses private insurance and their employment ends.
- TRICARE.TRICARE provides coverage for active and retired members of the military and their dependents. You can have both TRICARE and Medicare if you:
- are age 65 or over and enrolled in Medicare Part B
- have a disability, end stage renal disease , or amyotrophic lateral sclerosis and are enrolled in both Medicare Part A and Part B
- have Medicare and are a dependent of an active duty service member with TRICARE
Now that weve seen when you may have both Medicare and private insurance, lets discuss who pays first in each situation.
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