Veterans Administration Medical Benefits and Original Medicare

If you have Veterans Administration Medical Benefits and Original Medicare eligibility has become an issue, you probably have a lot of questions and/or concerns regarding which coverage you should utilize for your health care. If you have enrolled for Veterans Administration Medical Benefits and become original Medicare eligible, you do not have to enroll in Medicare; however, the Veterans Administration encourages all veterans to take advantage of alternative health coverage if eligible. Therefore, it is recommended that you enroll in original Medicare.

How will I benefit from having Veterans Administration Medical Benefits and Original Medicare?

Veterans who are enrolled in both the Veterans Administration Health Benefits Package and original Medicare may take advantage of benefits in either program. The programs are independent and do not coordinate. To receive benefits from the Veterans Administration Health Benefits Package, enrolled veterans must go to Veterans Administration facilities. An enrolled veteran cannot use his or her original Medicare card at a Veterans Administration facility because the Veterans Administration cannot bill Medicare. In order to use original Medicare, veterans must go to doctors and facilities that accept original Medicare assignment, meaning they accept original Medicare’s approved amount for any given service as payment in full. Veterans are responsible for paying all original Medicare Part A and/or Part B premiums, deductibles and co-insurance. The Veterans Administration does not pay for these Medicare costs.

If I enroll in Veterans Administration Medical Benefits and original Medicare, do I need Medicare Part A and Part B?

Original Medicare Part A (hospital insurance) carries no premium as long as the veteran has worked ten years. Therefore, it only makes sense to enroll in original Medicare Part A if there is no premium.

Original Medicare Part B (medical insurance) carries a premium of $104.90 (in 2013) which the veteran would be responsible for paying. Veterans who do not enroll in original Medicare Part B must go to Veterans Administration facilities for all out-patient medical services such as doctor visits, preventive care, and durable medical equipment. If he or she decide to enroll in original Medicare Part B outside of his or her initial enrollment period, or when they first became eligible for original Medicare, then the veteran would have to pay the late enrollment penalty, which is 10% of the current original Medicare Part B premium for every 12-month period. Additionally, outside of the initial enrollment period the veteran is restricted to only enrolling in original Medicare Part B during Medicare’s General Enrollment Period, which is January 1st to March 31st of each year. If the veteran enrolls in original Medicare Part B during Medicare’s General Enrollment Period, his or her original Medicare Part B would become effective the following July 1st.

 

Veterans who enroll in original Medicare Part A only are limited to using Veterans Administration facilities except for original Medicare Part A benefits. In such cases, they would have to pay the original Medicare Part A deductible and copays if they received Part A covered services outside of Veterans Administration facilities. (See “What is Medicare” for specifics regarding original Medicare deductibles, copays and co-insurances.)

If I have Veterans Administration Medical Benefits and original Medicare, do I need Part D?

If veterans are also enrolled in Medicare Part D (also known as “Prescription Drug Plan”), they may use either Veterans Administration pharmacies and mail order service, or their Prescription Drug Plan’s network local retail pharmacies and mail order service, depending on who writes the prescription. Prescriptions written by Veterans Administration providers may be filled at either Veterans Administration or non-Veterans Administration pharmacies or mail order services. At a Veterans Administration pharmacy, most veterans are charged a co-payment of $8 for a brand-name or generic drug for each 30-day or less supply. If a veteran has a Medicare Prescription Drug Plan, the plan’s copayment may be more or less for the same prescription. For example, if the prescription was for a generic drug, the Prescription Drug Plan’s copayment may be less than $8, thus the veteran may save some money by filling the prescription at the Medicare Prescription Drug Plan’s pharmacy. Prescriptions written by non-Veterans Administration providers cannot be filled at Veterans Administration pharmacies or mail order services. Thus, a veteran must fill prescriptions written by non-Veterans Administration providers at his or her Medicare Prescription Drug Plan’s pharmacies and mail order services.

It is important to note that if a veteran decides to enroll in a Medicare Prescription Drug Plan outside of the initial enrollment period, or when he or she first becomes eligible for original Medicare, they may enroll only during the Annual Election Period which is October 15th to December 7th of each year, but will not be charged a late enrollment penalty because the Veterans Administration prescription drug coverage is creditable coverage.

If I enroll in Veterans Administration Medical Benefits and original Medicare, do I need Medicare insurance?

First, in order to purchase Medicare insurance, such as a Medicare Advantage plan or a Medicare Supplement, you must have original Medicare Part A and Part B. Whether you purchase Medicare insurance in addition to Veterans Administration Medical Benefits and original Medicare depends on the amount of coverage you want. Keep in mind that you can only use the Veterans Administration facilities with your Veterans Administration Medical Benefits so you are limited to what services the facility offers. With original Medicare Part A and Part B you can go anywhere that accepts Medicare assignment. You would be responsible for the deductibles, copays and co-insurances that original Medicare leave you responsible for paying. Therefore, Medicare Pathways recommends that you purchase a form of Medicare insurance to supplement your original Medicare Part A and Part B should you have to receive treatment outside of the Veterans Administration facilities.

Additionally, if you have to travel a good distance to the closest Veterans Administration facility for routine procedures, such as blood work, x-rays, etc. then perhaps a Medicare insurance plan would allow you to undergo these procedures at a facility closer to your residence.

A Medicare Pathways Benefit Advisor can review your options with you and recommend a plan that will assist with your original Medicare in those cases that you may have to go outside the Veterans Administration facilities. You can contact a Benefit Advisor by calling 1-866-466-9118 or you can click here to request a quote and a Benefit Advisor will contact you.

 

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Medicare Pathways, Inc.  1-866-466-9118