The world of veteran’s benefits can be confusing, and it can be difficult to know how much coverage you really have. Supplementing your veteran’s healthcare coverage with a Medicare plan may be a good idea, especially because Veteran’s Administration (VA) healthcare coverage can vary drastically from person to person and over time.
Here, we will look at the different Medicare plans, TRICARE, and VA Medical Benefits and how they all work together.
The healthcare coverage provided by the VA is a different healthcare system than Medicare. Typically, these systems do not interact with each other, so it is often up to the veteran to understand what coverage is provided by each plan.
VA healthcare coverage
VA healthcare covers services for medical conditions that are both service- and non-service-related. To receive 100 percent coverage, you must seek care in a VA hospital or clinic.
If you receive care in a non-VA medical facility, you may have to pay a copay. In some cases, the VA may authorize care in a non-VA facility, but this must be approved in advance of treatment.
So, what if you receive care in a non-VA facility for a condition that’s not service-related and isn’t covered by your VA insurance plan? If you’re over 65, this is where Medicare helps.
By opting into each part of Medicare, you’re building more comprehensive healthcare coverage for yourself. You’ll also be less likely to pay high out-of-pocket costs.
Next, let’s take a look at the different parts of Medicare.
Medicare Part A
Medicare Part A is usually free and doesn’t have a premium. This part covers non-VA hospital care if you have an emergency or if you live far away from a VA facility.
Medicare Part B
Medicare Part B offers more coverage options for non-VA healthcare providers as well as other things that your VA healthcare plan may not cover.
VA coverage can change over time depending on funding from Congress. If funding is cut for VA healthcare coverage, veterans are prioritized according to need. This means permanent VA healthcare coverage is not guaranteed, which is important to remember when considering another healthcare plan as supplemental coverage.
It is important to note that if you do not sign up for Medicare Part B right away and later lose your VA coverage, a late enrollment fee will apply.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, offers healthcare coverage that the VA and basic Medicare do not. This includes dental, vision, hearing, prescription drugs, and more.
There are some other factors to consider when deciding whether Medicare Advantage is right for you. On top of the added coverage benefits, Medicare Advantage plans offer bundled coverage for all your healthcare services, various plan options to choose from, and often long-term cost-savings.
However, there are some potential disadvantages to consider as well, including additional plan costs, having to stay within a provider network, and lack of coverage while traveling.
Consider your specific coverage needs and budget when deciding which type of plan will work best for you.
Medicare Part D
Medicare Part D is a prescription drug plan. Although it generally has higher drug prices than the VA plan, it may cover drugs that are not covered by the VA. Part D plans also allow you to go to your preferred retail pharmacy and fill prescriptions from non-VA doctors.
However, if you do not immediately sign up for Part D, there is an added surcharge once you enroll if you’ve gone without any prescription drug coverage for 63 consecutive days.
If you are having trouble covering the expense of your medications, you may qualify for Medicare’s Extra Help assistance program. Also known as Part D Low-Income Subsidy, this program provides additional prescription assistance based on your income and level of financial need.
Supplemental plans, such as Medigap, are useful for covering emergency situations or for when you are traveling outside the U.S. They are also helpful if you do not live near a VA-approved provider or medical facility, or if you are in a lower-priority VA benefit group.
When you have VA healthcare coverage, the VA pays for doctor visits, prescriptions from VA providers, and visits to a VA facility. Medicare will pay for any services and prescriptions from non-VA healthcare providers and facilities.
There may be times when both the VA and Medicare will pay. This may happen if you go to a non-VA hospital for a VA-approved service or treatment, but need additional procedures that aren’t covered by the VA healthcare plan. Medicare will pick up some of those additional costs.
Remember though, you are still responsible for your Part B premium and 20 percent copay or coinsurance fees.
When in doubt, you can always contact the VA and Medicare for any specific coverage questions.
Contact Your coverage providers
- For VA healthcare coverage questions, call 844-698-2311
- For Medicare coverage questions, call 800-MEDICARE
TRICARE is the military’s medical insurance provider. It’s broken down into several different plans, based on your military status. These plans include:
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Prime Overseas
- TRICARE Prime Remote Overseas
- TRICARE Select
- TRICARE Select Overseas
- TRICARE For Life
- TRICARE Reserve Select
- TRICARE Retired Reserve
- TRICARE Young Adult
- US Family Health Plan
After you retire from military service and reach age 65, you will be eligible for TRICARE for Life if you are enrolled in Medicare parts A and B.
Tricare for Life is consider a second payer. This means that your Medicare plan is billed first for any medical services you receive. After Medicare pays, Tricare will pay the rest, if they cover those services.
You go to your annual physical and you are referred to a cardiologist for the first time. At the cardiology visit, you are told you need to have an echocardiogram and a stress test.
Your primary care doctor, cardiologist, and the facility where you receive those tests will all bill your Medicare plan first. Once Medicare pays for everything that is covered under your plan, the remainder of the bill automatically gets sent to TRICARE.
Your TRICARE plan will cover the leftover costs that Medicare did not pay for, as well as any coinsurance and deductibles you may owe.
You may enroll in Tricare for Life during TRICARE’s open enrollment season, which begins in November. You may also enroll outside of the open season if you have a qualifying life event such as retirement from active duty, marriage, or death of a family member. You have 90 days after a qualifying life event to change your coverage or enrollment.
You can easily enroll in Medicare online. There are just a few things to remember:
- If you are approaching age 65, you may enroll during the initial enrollment period. Enrollment in Medicare parts A and B begins 3 months before you turn 65, the month of your birthday, and 3 months after you turn 65.
- If you are not enrolled, want to make changes to an existing Medicare part A or B, or are over the age of 65 but still looking to enroll, the open enrollment period is January 1 — March 31 every year.
To get started with enrollment, visit Medicare’s enrollment page and follow the prompts.
If you are looking to supplement your Medicare and VA coverage with additional plans, you have a few options:
- Medicare Advantage (Part C)
- Medicare Part D
These plans are available through private insurance companies and can cover extra out-of-pocket expenses that are not covered by VA health plans or Medicare. These expenses might include:
- coinsurance, copays, or premiums from Medicare Part B
- prescription drug costs
- medical equipment
- vision services to help pay for glasses and contacts
- dental, including preventive and treatment coverage
- prescription drug coverage
- hearing services to help pay for hearing aids and tests
- fitness or wellness programs, including gym memberships
When considering additional coverage, research what services are already covered by your existing plans. If you think you’ll need more coverage in the future or have been recently diagnosed with a chronic illness, you may want to consider purchasing supplemental plans.
Here are a few questions to ask yourself as you consider the right coverage option for you:
- Are your preferred prescriptions and doctors included in your existing coverage?
- Is there a possibility you’ll need medical equipment or several medical treatments in the near future?
- If you don’t have any chronic conditions, do you have too much coverage? Will you use it?
How do I keep my costs low?
If cost is an issue, there are $0 premium Medicare Advantage plans. Keep in mind, there may be limitations in coverage and what providers you may see. You may also use other assistance programs like Medicaid and Extra Help, if you meet the eligibility requirements.
If you are a veteran with VA healthcare coverage and are over 65, enrolling in a Medicare plan can provide more well-rounded coverage.
VA and TRICARE plans can be supplemented with Medicare plans. Additional supplemental plans are available through Medicare, and you can choose one that meets your specific cost and benefits needs.
There are many options to help you create a more balanced health care program after age 65.