As a veteran, you’re entitled to medical coverage through the Veterans Affairs (VA) health program, but if you’re approaching the age of 65, you’re also eligible for Medicare benefits. While VA benefits cover services received at a VA facility, there are certain cases where you may need to visit a non-VA facility for medical care. In these cases, enrolling in a Medicare plan can significantly reduce or even eliminate your out-of-pocket costs.
Here’s what you need to know about how enrolling in both these programs might provide you with greater coverage and better options when it comes to the types of healthcare services you can receive and where you can receive them.
VA Benefits
Every veteran, regardless of age, receives a benefits package through the U.S. Department of Veterans Affairs that’s completely unique to their needs. Most medical care and services are covered, but things like dental or vision services may not be. Services are covered according to the following criteria:
- Your priority group: You’re assigned to 1 of 8 priority groups based on military service history, disability rating, income level, Medicaid eligibility and other benefits you receive, like VA pension benefits
- The advice of your primary care provider regarding your specific conditions
- Accepted medical standards for treating your specific conditions
Keep in mind that VA benefits cover medical services received at a VA facility only. This may not be a convenient option for you in terms of travel to the VA facility, or even if you want to receive care from a specific doctor outside of the VA system.
Many veterans find that enrolling in a Medicare plan in addition to their VA plan can provide convenience and savings when it comes to receiving and paying for healthcare services.
Medicare Benefits
While VA benefits and Medicare are completely separate, enrolling in both programs greatly expands your ability to receive coverage for medical services.
Enrolling in Medicare may not only provide you with wider coverage in terms of health conditions, but it also gives you much greater choice when it comes to where you receive services. Medicare covers healthcare services at non-VA facilities that accept your Medicare plan. This is particularly important if access to a VA facility is inconvenient for you. Some veterans live very far from a VA facility, making travel an added expense and a hassle. Additionally, while wait times at VA facilities have significantly decreased in recent years, it’s still a concern for some veterans.
Enrolling in Medicare provides greater flexibility and convenience for senior veterans. Here’s how Medicare plans can supplement your VA benefits.
Medicare Part A
All senior veterans are highly encouraged to enroll in Medicare Part A in addition to VA participation. In most cases, you won’t pay a monthly premium for Part A coverage as long as you meet certain eligibility requirements.
In general, Part A covers:
- Inpatient care in a hospital
- Temporary nursing home care following an illness or injury
- Skilled nursing facility care
- Hospice care
- Home health care
Medicare Part B
It’s highly recommended that veterans enroll in Medicare Part B, as well. Part B coverage provides you with a variety of outpatient services outside the VA system. Be sure to enroll in this option as soon as it becomes available to you, since you may experience a gap in coverage or face a penalty for each 12-month period you lack Part B coverage.
Part B covers the following types of services.
Medically necessary services: If you have a medical condition that requires diagnosis or treatment, Part B covers the necessary services and supplies as long as they meet accepted medical practice standards. Specifically, Part B can give you coverage for:
- Clinical research
- Durable medical equipment
- Ambulance services
- Inpatient and outpatient mental health services
- Some outpatient prescription drugs
Preventive care: If you need preventive services, such as those that prevent or mitigate the effects of the flu, Part B covers them as long as you get treatment from a healthcare provider who accepts assignment.
Medicare Part C
Medicare Part C is also known as a Medicare Advantage plan, and it’s smart to sign up for this coverage if you need health services in addition to those provided through your VA benefits and/or Original Medicare. Providers include Medicare-approved private companies, and they have to follow all standards and rules set by Medicare.
While some of the services covered by Part C may overlap with those of the VA, a Medicare Advantage plan might be a better choice for your needs depending on the locations of your healthcare providers and the time, expense and effort it takes to travel to their facilities.
Be sure to check with the plan before you schedule service to find out exactly what’s covered and the out-of-pocket costs you’ll have to pay. Part C plans may cover the following medical needs, in addition to those included in Medicare Part A and Part B:
- Vision services
- Hearing services
- Dental care
- Prescription drug coverage
- Approved health and wellness programs
Medicare Part D
Veterans can take advantage of VA prescription drug benefits as well as a Medicare Part D drug plan. You might not always need one, though. VA benefits typically provide premium-free drug coverage. However, if the approved pharmacy locations or the Consolidated Mail Outpatient Pharmacy Program (CMOP) is not convenient for your healthcare needs, it may be wise to enroll in Part D or a Part C plan that includes prescription drug coverage.
The enrollment requirements for Part D are more flexible than those for other Medicare plans, and you can enroll without a penalty at a later time as long as you’ve maintained another form of prescription drug coverage.
While all Part D plans must cover enrollees in certain protected classes, including HIV/AIDS and cancer patients, you’ll have to choose a plan that covers drugs related to your healthcare needs. Generally, Part D plans place drugs into tiered levels on their list of covered drugs, and drugs in each tier may require you to pay different out-of-pocket costs. Put simply, drugs in lower tiers cost less than those in higher tiers.
Medicare Supplemental Insurance (Medigap)
If you sign up for Medicare during the initial six-month enrollment period, you’ll have the option to select a Medigap policy. These policies cover portions of your healthcare costs that Medicare doesn’t pay, including deductibles, coinsurance and copays.
Medigap plans are ideal for veterans who live far from a VA facility or those who are in a lower-priority VA group. If you plan to use Medicare Part B medical insurance to visit non-VA healthcare providers, a Medigap policy can be helpful in covering your out-of-pocket Part B costs.
Medigap policies can also help senior veterans who frequently travel outside the U.S. Some plans will cover international care services that Medicare won’t. Medicare will pay its share, then the Medigap policy will pay its share, significantly reducing your out-of-pocket costs should you require medical care during your travels.
Navigating both VA and Medicare benefits can be a tedious and confusing process, even if you’re familiar with the various levels of coverage. If you have any questions or need help finding a Medicare plan that works with your VA benefits, contact SeniorCare Benefits. We represent a range of plans and will help you identify the right coverage to protect your health for years. Call us today at 1-888-230-0269 so one of our agents can assist you.
