Health benefits

Veterans receiving VA health benefits should be sure to consider Medicare

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For military veterans, turning 65 may come with a health care decision: whether or not to enroll in Medicare.

Those who use Tricare and are considering enrolling in Tricare for Life – an insurance program administered by the Department of Defense – usually have no choice: the latter is only available in conjunction with Medicare Part A. (hospital coverage) and Part B (outpatient care coverage). Yet for vets who rely on the benefits of Veterans Health Administration, the decision might be less clear.

“My dad is a Vietnam War vet and at the age of 65 he asked me if he should just use the VA and save those bounties for parts B and D [prescription drug coverage]”said Danielle Roberts, co-founder of insurance company Boomer Benefits.

If you only have VA coverage and they can’t see you until next week, you’ll be stuck.

Danielle Roberts

Co-founder of Boomer Benefits

“He didn’t want to spend the money but I insisted and… I was very glad I did,” said Roberts.

The VA Health System provides care to 9 million ex-combatants each year at its 1,293 facilities, including 171 medical centers and more than 1,112 outpatient sites across the country.

However, it generally does not cover care outside of these locations.

“If you only have VA coverage and they can’t see you until next week, you’ll be stuck,” Roberts said. “But if you were enrolled in Medicare Parts A and B, you would have an option for VA-free treatment at another hospital or doctor’s office.”

Many health care providers accept Medicare. The VA itself encourages vets – whose VA coverage may differ from person to person depending on their health and military history – to enroll as soon as they are eligible (this does not affect VA benefits). You have seven months to register: The registration period begins three months before the month of your 65th birthday and ends three months after it.

Another reason to register: if you decide not to and change your mind later, you risk late registration penalties. For Part B, this fee is 10% of the standard monthly premium (which is $ 148.50 for 2021 and a projection of $ 158.50 for 2022). The amount is paid monthly and generally lasts as long as you are enrolled in Medicare.

Part D (prescription drug coverage) does not carry a late registration penalty for people receiving VA health care because its drug benefits are considered “eligible” by the Medicare program.

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Nonetheless, some people who use VA healthcare are signing up so they can get their medications from non-VA doctors and have their prescriptions filled at their local pharmacy rather than the VA mail-order service, which manages around 80% of outpatient prescriptions for these veterans.

Some vets decide to get their Part A and B benefits through a Medicare Advantage plan – which may come with a zero premium (in addition to your Part B premium), said Elizabeth Gavino, founder of Lewin & Gavino and independent broker and general agent. for health insurance plans. Or, it might help you with your Part B bonus.

“There are many Advantage plans that offer a Part B premium discount,” Gavino said. “This is usually a portion of the premium that is reimbursed by the plan.”

Advantage plans also typically include Part D coverage and often offer additional benefits such as gym membership, acupuncture, chiropractic visits, vision services or hearing aids, Gavino said.

However, they have their own cost structure, which means that deductibles, copayments or coinsurance may differ from plan to plan. However, unlike Parts A and B, Advantage plans come with an annual maximum amount.

Meanwhile, some people with VA health care who enroll in Medicare decide to get a policy called Medigap instead of an Advantage plan (you can’t have both).

This type of supplemental insurance covers the cost of certain deductibles, copayments, and co-insurances associated with Medicare. However, you usually only have six months to purchase a Medigap policy without an insurance company digging into your medical history and deciding whether or not to insure you, unless you’re in a state with different rules. This “guaranteed issue” period begins when you first enroll in Medicare.

After this window, you may need to go through medical underwriting. And depending on your condition, this process could cause the insurer Medigap to charge you more or deny coverage altogether.