Whether you’re a senior veteran or a younger vet with disabilities, it’s important to understand how Medicare complements your VA benefits. Today, we’re taking a look at what you need to know so you can take advantage of your coverage. Ready? Let’s dive in.
Introduction to Medicare and VA Healthcare Benefits
You might not think you need Medicare if you are a veteran. But there’s a lot of advantages to enrolling when you qualify for it. Medicare can provide another layer of coverage to your VA benefits, adding convenience and flexibility to your healthcare.
Key Features of Medicare for Veterans
Medicare and Medicare Advantage offer several key features that can significantly benefit you as a veteran. Among them are:
- Flexibility – Medicare coverage allows you to receive care outside the VA system as long as the provider or facility is authorized by Medicare. This allows veterans to stay closer to home if they don’t live near a VA facility.
- Prescription drug coverage – Veterans with VA prescription drug benefits may still choose to enroll in Medicare Part D. This allows them to get medications from non-VA providers and use a local pharmacy instead of the VA mail-order service. Many Medicare Advantage plans also include prescription drug coverage. These are known as MAPD plans.
- Dental and vision coverage – Many Medicare Advantage plans offer coverage for routine dental and vision care. This can be helpful for veterans who do not qualify for these services through their VA benefits package.
Overview of VA Healthcare Benefits
VA benefits aim to provide veterans with comprehensive, high-quality healthcare so they get the attention and support they deserve for their service to the nation. Each veteran’s coverage is unique and may include:
- Preventive care, including annual exams and immunizations
- Inpatient hospital services, like surgeries, dialysis, and specialized care
- Urgent and emergency care
- Mental health services for conditions like PTSD, depression, and substance abuse
- Assisted living and home healthcare
- Other services as determined by a VA primary care provider (PCP)
You can take advantage of these benefits to receive timely and personalized care from healthcare professionals who understand the specific challenges and experiences faced by veterans.
VA Healthcare Eligibility Criteria
VA healthcare benefits vary for every veteran and are determined by priority groups. They not only affect what services are covered, but how much you may have to pay for them. VA healthcare eligibility is based on factors like:
- Military service history
- Discharge status
- Disability
- Income
Eligibility and coverage level of each individual of this is determined on a case-by-case basis. You can contact your local VA office to learn more.
Medicare Eligibility Criteria for Veterans
Medicare eligibility for veterans is basically the same as for non-vets. It should be noted that the VA encourages veterans who don’t have insurance through their job to sign up for Medicare Parts A and B (also known as Original Medicare) as soon as they qualify. There are a few reasons for this.
First, future funding of the VA by Congress at the current level is not guaranteed. Having Medicare coverage can provide peace of mind should VA benefits be reduced. Second, every individual (including veterans) that fails to sign up for Medicare Part B when first eligible may face a penalty if they need to sign up later.
Qualifying for Medicare Based on Age or Disability
If you already have VA benefits and qualify for Medicare at age 65, you can be enrolled in both. Some people under 65 can also qualify if they have certain disabilities, including End-Stage Renal Disease (ESRD) and Lou Gehrig’s disease, or ALS. You won’t lose your coverage through the VA when you enroll in Medicare, and vice versa.
Enrollment Periods and Sign-Up Procedures
If you don’t sign up for Medicare when you turn 65 during the initial enrollment period, you may have to wait until the next general enrollment period, which takes place from January 1 to March 31 each year. However, if you experience a life-changing event like moving or loss of current coverage, you may be able to enroll during a special enrollment period.
Coordinating Medicare and VA Benefits
Medicare and VA benefits aren’t actually connected. Instead, you decide which benefits you want to use when you need care. When you choose to use your VA benefits, you must visit a VA doctor or facility. In some cases, the VA will cover your care at a non-VA facility as long as it’s pre-authorized. When using your Medicare benefits, you must receive care at a Medicare-authorized facility. Always remember to inform your primary care provider (PCP) about any additional care you’re receiving to better coordinate your benefits.
Enrollment Considerations and Planning
One of the more important things to keep in mind when you’re considering enrolling in Medicare is your current VA benefits. If they meet all your existing healthcare needs, you may want to delay signing up for Medicare. But be careful because doing so may result in a penalty. If your healthcare needs change, or if you want to move to a new area that is not close to a VA facility, this may impact your ability to get your care covered.
Impact on Out-of-Pocket Costs
How much veterans will pay for VA benefits depends entirely on their eligibility criteria and varies widely from person to person. First, determine your coverage level through the VA and identify what additional benefits you may need based on your health status and preferences. Then you'll be able to determine your Medicare needs and shop for a Medicare Advantage plan that will best complement your coverage. Leveraging both gives you the most comprehensive care with the least amount of financial strain.
Want to know more? Contact us today for help with your Medicare enrollment options and to find a Wellcare Medicare Advantage Plan that’s right for you.
Which Medicare Advantage Plan is right for you?
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More About Medicare Eligibility
- What Age Is Eligible for Medicare?
- How to Qualify for Both Medicare and Medicaid
- What Disabilities Qualify for Medicare?
Sources
HHS.gov - Who Is Eligible for Medicare
VA.gov - Find a location
VA.gov - VA Priority Groups
VA.gov - VA Health Benefits
