Veterans that are eligible for benefits are typically covered by either the Veterans Administration or TRICARE. When they reach age 65, making a decision on whether or not to sign up for Medicare and other coverage can be confusing.
Should I Sign Up for Medicare? According to the VA’s website, they encourage beneficiaries to sign up for Medicare as soon as they can, this is because: • There’s no guarantee that Congress will provide enough funding in future years for the VA to provide care to all Veterans who are signed up for VA health care. If they are in one of the lower priority groups (i.e., Groups 6-8), they could lose their VA health care benefits in the future. • Having Medicare means they are covered if they need to go to a non-VA hospital or doctor, so they have more options to choose from. Depending on a beneficiary’s location to the nearest VA facility or hospital, it may be in their best interest to pursue options with Medicare coverage.
Part D – Prescription Insurance VA is creditable coverage towards Part D, so beneficiaries can choose whether or not they want to add Part D coverage at any time without risk of receiving a penalty. The VA drug program only covers medications that have been prescribed by VA doctors, and only fills those prescriptions through the VA mail-order service. If a beneficiary is diagnosed with a condition by a doctor that’s not part of the VA network, they will need to fill those prescriptions at a local retail pharmacy and could use Part D to cover the costs.
Medicare & TRICARE Out of the 11 TRICARE programs available, once an eligible beneficiary qualifies for Medicare A and B they are automatically enrolled in TRICARE For Life, a Medicare-wraparound coverage. Even if the beneficiary only has Part A, they are required to sign up for Part B in order to continue their coverage through TRICARE. How It Works TRICARE For Life (TFL) beneficiaries can go to any Medicare facility or provider across the nation. TFL is secondary payer to Medicare in the United States and its territories, so claims are processed as such: • Provider files the claim with Medicare • Medicare pays its portion and send the claim to TFL for processing • TFL pays the provider directly for TRICARE-covered services There are no enrollment fees for TFL, but they must pay their Part B premiums.
Can You Get Other Coverage? Over and above Part A and Part B benefits, Veterans have options to sign up for additional coverage to help cover potential out-of-pocket exposure like traditional Medicare beneficiaries.
VA Benefits & Other Coverage Medicare Supplement Since Medicare and VA benefits don’t mix, VA health care recipients can choose to sign up for a Medicare Supplement plan to complement their Part A and Part B coverage. This will give them access to Medicare providers and facilities nationwide in the event that obtaining care through the VA system isn’t feasible, or the VA refuses to treat a specific illness or chronic condition. Medicare Advantage Once again, VA beneficiaries can enroll in a Medicare Advantage plan to access their Medicare benefits at contracted providers in their service area. Depending on the need for Part D coverage, many VA health care recipients choose plans without drug coverage, sometime referred to as MA-only plans. TRICARE For Life & Other Coverage Medicare Supplement Yes, TFL beneficiaries can sign up for a Medicare Supplement plan, but that may interfere with their TFL benefits. Since TFL is the secondary payer to Medicare, and care must be received by a Medicare provider, signing up for a Medicare Supplement plan will cause TFL to become the payer of last resort. Since FTL is offered at no cost, signing up for a Medicare supplement plan is considered duplication of coverage and is not advised. Medicare Advantage TFL beneficiaries can enroll in a Medicare Advantage plan and retain the ability for TFL to be the secondary payer. This will allow the TFL member to utilize the MA plan’s network and ancillary benefits, but still provide a way for their out-of-pocket costs to be covered. Once a claim is incurred with the MA plan, the beneficiary needs to pay any applicable copays to the provider, then submit a paper claim with the FTL contractor, Wisconsin Physician Services (WPS). WPS will process the claim and pay TRICARE’s portion directly to them. In Summary Veterans have options when it comes to their Medicare coverage. While enrollment in Medicare is required for TRICARE For Life members, it is optional but strongly encouraged for those covered by VA Health Care Benefits. VA is creditable coverage for the sake of delaying enrollment in Part D but will give them access to cover prescriptions that were prescribed by a non-VA physician and filled at a non-VA pharmacy. Each situation is unique, and Veterans are encouraged to plan for their Medicare benefits prior to turning age 65 so no opportunity is missed.
Sources • https://www.va.gov/health-care/about-va-health-benefits/va-health-care-and-otherinsurance/ • https://www.tricare.mil/medicare