Saturday, December 02, 2023

I am a Medicare veteran, what else do I need?

by LYNN BRYAN Contributing Writer
| November 11, 2021 1:00 AM

I am a Medicare veteran, what else do I need?

The better question may be, are there more benefits I am entitled to? As a fellow veteran, I know it may seem like we’re all set when it comes to health care; but are we missing out on benefits? This article provides a brief overview of several federal programs and how they can work together to maximize the veterans and their spouses Medicare coverage.

As you know, Medicare is the federal health care program for folks aged 65 and older or those determined disabled by the Social Security Administration. Original Medicare, enacted in 1965 includes Part A, hospital insurance and most people have no additional monthly premium. Part B, medical insurance covers basic outpatient care. The Part B monthly premium in 2021 is $148.50. Parts A & B are designed to cover about 80% of one’s health care costs. It’s up to the beneficiary to determine the best way to insure the other 20% and prescription drugs (Part D).

The military retired service member and their spouses receive healthcare through the TRICARE system until they reach Medicare age or eligibility when they will transition to TRICARE for Life. TRICARE For Life is Medicare-wraparound coverage for beneficiaries who have Medicare Parts A & B. Meaning TFL covers the 20% that Original Medicare does not and provides prescription drug coverage. In order to maintain TRICARE benefits, members must enroll in Medicare when first eligible.

Retirees and non-retired Veterans are eligible for care through the Veterans Administration based on their service and any medical conditions that may have resulted from that service. There are many classifications of disabilities that are translated into percentages and priority groups. Most Veterans, utilize the VA for their prescriptions. If a Veteran is determined 100% service-connected disabled, his/her spouse may be entitled to civilian healthcare benefits and drug coverage through a program called CHAMPVA.

Now, in my second career as a Medicare Specialist, a question I am often asked is: “I am a Veteran and use the VA, should I enroll in Medicare Part B?”. The short answer is yes, there are many reasons. In the event of an emergency the Veteran will be taken to the nearest hospital. If the emergency is service connected, the cost will likely be covered by the VA. However, if the emergency is not service connected, the Veteran may be responsible for all the costs versus the 20% if enrolled in both parts of Medicare.

Another reason can be found on the Veterans Administration’s website,

Under the section titled:

“VA health care and other insurance

If I already have VA Health care benefits, should I still sign up for Medicare Part B when I turn 65?

Yes. We encourage you to sign up for Medicare as soon as you can. This is because:

• We don’t know if Congress will provide enough funding in future years for us to provide care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future.”

• The VA itself is encouraging veterans to fully participate in Medicare. The website could go further and inform veterans that anyone who has Medicare Parts A & B is able to enroll into ANY Medicare Advantage plan available in the county they live. Advantage Plans are independent and offer separate coverage that can be used in addition to and as a back up to their VA benefits.

• Medicare Advantage plans, known as Part C, must be approved by CMS the Centers for Medicare and Medicaid, the Federal Agency that oversees the Medicare Program. In recent years plans have been created specifically with Veterans in mind. They have names like the Patriot, Honor and Eagle Plans. These plans provide outstanding extra health care benefits such as dental, vision, hearing, chiropractic, fitness memberships and emergency coverage at no cost to the Veteran. Additionally, Veterans who have Medicare Parts A & B, TRICARE for Life, CHAMPVA or use the VA for prescriptions can enroll in these $0 premium Advantage Plans designed to complement their coverage, add benefits and receive a Medicare Part B premium reduction from the Social Security Administration.

Of course, the big picture goal of these programs is to help veterans live healthier lives. Insurance is a product we choose to buy to give us peace of mind. In the case of a $0 premium Advantage plan we can simply add peace of mind without adding any costs. All Veterans have earned their health care benefits through their service and those older or disabled Veterans have earned Medicare through their tax dollars and monthly premiums. As a veteran enrolled in TRICARE and who uses the VA, I am sincerely grateful to each of you for your service. You paved the way for me. Thank you and Happy Veterans Day!

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