Pairing veteran's health coverage with Medicare
If a veteran is interested in pairing veteran’s health coverage with Medicare, it is important to do a thorough needs analysis to assess if and how these plans work together. If you would like to schedule a meeting with one of our licensed agents to discuss how your Medicare coverage works, call Health Benefits Associates today.
Enrolling in a Medicare Advantage Only Plan
TRICARE for Life
If a TFL beneficiary chooses to enroll in a Medicare Advantage (MA) Only plan, the plan will replace original Medicare as their primary coverage. On most MA plans the individual will need to stay within a specific provider network. Some plan options may not be suitable to pair with TFL but there may be other options that can work.
CHAMPVA beneficiaries may enroll in an MA only plan. Just as it does on TFL, the MA only plan would replace original Medicare as the primary coverage and the individual would want to stay within a specific network of doctors. Talk with a Medicare expert to see if it is beneficial to pair CHAMPVA with a MA plan.
The VA and Medicare are two different entities and do not coordinate benefits. Because of that, someone that uses VA health benefits and is enrolled in Medicare Part A and B, is also eligible to enroll in a Medicare Advantage Only plan. Such plans would not cover expenses at the VA but would provide the beneficiary with more options to seek medical services and may provide ancillary benefits such as dental, vision, and hearing that might not be covered by the VA.
Enrolling in a Medicare Advantage Prescription Drug (MAPD) Plan
TRICARE for Life
TRICARE for Life offers more comprehensive medical and prescription coverage than a MAPD Plan. The MAPD plan would replace Original Medicare and become primary to their TFL. It would also cause TFL prescription benefit to become secondary to the MAPD. While someone can enroll, it may not be in their best interest to enroll.
CHAMPVA offers creditable medical and prescription drug coverage. Enrolling in an MAPD would make the plan their primary coverage and CHAMPVA their secondary coverage. It would also disrupt their access to the mail order pharmacy utilized by most CHAMPVA beneficiaries.
Much like a Medicare Advantage only plan, one can have a MAPD plan and not disrupt their VA coverage. Since there is no coordination of benefits, the VA Healthcare cannot bill Medicare Advantage and Medicare Advantage cannot bill the VA. Enrolling in an MAPD plan would provide veterans with more choices and access to providers, second opinions, and prescription formulary options. The combination of VA Healthcare and a Medicare Advantage provides veterans with more options.
Enrolling in a Medicare Supplement Plan
TRICARE for Life
TFL acts as a Medicare Supplement policy. Although a member may enroll in a Medicare Supplement policy for additional coverage, it may not be necessary since they already have full coverage through TFL. Also, if enrolling in a Medicare Supplement, the beneficiary would have an additional monthly premium on top of their Part B premium.
Someone that is enrolled in Original Medicare and is a CHAMPVA member has little to no costs for approved medical expenses. Enrollment into a Medicare Supplement would add unnecessary premiums and be considered duplicate coverage.
A veteran is eligible to enroll in a Medicare Supplement policy if they are entitled to Part A and enrolled in Part B. Medicare Supplement plans have a monthly premium and typically have lower out of pocket expenses. These types of policies allow you to see in doctor or hospital in the United States that accepts Original Medicare. Enrolling in a Medicare Supplement plan would provide veterans more coverage in addition to the VA.
Enrolling in a Prescription Drug Plan
TRICARE for Life
TFL beneficiaries already have creditable drug coverage. Usually, TFL drug coverage provides a more comprehensive plan with no coverage gap. If one were to enroll in a stand-alone PDP while on TFL, then the PDP would become primary to their TFL drug benefit.
Beneficiaries that are eligible for CHAMPVA already have creditable drug coverage. Enrolling a beneficiary into a stand-alone PDP would cause the plan to become their primary coverage making their CHAMPVA prescription coverage secondary and will disrupt access to their mail order pharmacy.
VA health benefits offer creditable drug coverage that is considered equal to or exceeds the actuarial value of standard Medicare Part D prescription drug coverage. With that, the VA will only fill prescriptions prescribed by a private physician if certain stipulations apply, otherwise, it does not typically fill prescriptions written by non-VA providers. Since the VA and Medicare do not coordinate benefits, a veteran can use both the VA and a stand-alone PDP. The PDP would allow the beneficiary more options to fill their prescriptions.
If you are a veteran and currently eligible for military sponsored healthcare coverage, contact a member from our team at (775) 828-1216 to schedule an appointment today to see how you can pair veteran’s health coverage with Medicare.