Do I Need Medicare If I Have Tricare? (A Veterans Perspective)
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Table of contents
- MEDICARE ADVANTAGE PLANS FOR VETERANS
- What does VA healthcare cover?
- How can I apply for VA Medical and Medicare Coverage as a Veteran?
- MEDICARE ADVANTAGE AND VA BENEFITS
- MEDICARE ADVANTAGE AND TRICARE FOR LIFE
- What if certain services are neither covered for by TFL or Medicare Advantage?
- TRICARE FOR LIFE ENROLLMENT
MEDICARE ADVANTAGE PLANS FOR VETERANS
Oftentimes, Veterans who qualify for Medicare get confused about their options for Medicare Advantage Plans. Some of them are eligible for Veteran coverage but are not sure how veteran coverage works simultaneously with Medicare. Different Veterans plans may operate with Medicare Advantage plan differently depending on the plan operators and the area of coverage.
The department of Veterans Affairs (VA) provides healthcare coverage to Military personnel, who can also enroll for Medicare as soon as they become eligible. Typically, Veteran plans include TRICARE, which is mainly for active-duty service members, military retirees, and members of their families.
If you have Tricare and still want to enroll in Medicare Advantage, you can do that. If you eventually do, the Medicare Advantage plan then stands as the Primary payer while Tricare, the secondary payer, takes care of the copayments on your Medicare Advantage plan, thereby cutting down your out-of-pocket expenses.
As a veteran, having both Medicare and VA benefits widens your coverage immensely. VA covers payment for Medical services if you visit a VA hospital or doctor. But if you need to go elsewhere, you may be required to pay for the whole expenses yourself, even in cases of emergencies. Nevertheless, if you have Medicare, you can afford to visit a non-VA provider and you’ll get the needed coverage. This will be of great importance to you if you live far away from the nearest VA facility.
As a veteran, having both Medicare and VA benefits widens your coverage to a great extent. It gives you access to benefits that only VA or Medicare plans cannot provide. To enroll in a Medicare Advantage plan in addition to your VA plan, you need to have Medicare Parts A and B. Medicare part B has a monthly premium and so does a Medicare Advantage plan. If you enroll in a Medicare Advantage plan in addition to VA coverage, you would be paying a minimum of 2 monthly premiums and up to 3 monthly premiums, including part D prescription drug plan.
What does VA healthcare cover?
Veterans enrolled in VA benefits are assigned a priority group, one through eight, and your priority number is determined by your income, disability and service history and this is also used in determining your copays. Veterans who sustained significant injuries through service that led to a disability will be placed in a higher priority group, which corresponds to a higher level of coverage.
VA healthcare cover a wide range of healthcare services for Veterans which may include:
- Preventive health testing
- Routine eye exams
- Nutrition and dieting counseling
- Flu shots and other immunizations
- Organ transplants
- Blood work
- Rehabilitation services
- Therapy and other mental health counseling
- Emergency care
To be eligible for coverage, it is required that veterans receive care at a preferred VA facility.
You may be eligible for VA benefits if you have a current condition that affects your body or mind and you meet at least one of the following requirements:
- You served on active duty, active duty for training, or inactive duty training and/or have a disability rating for your service-related condition.
- You have a pre-service disability claim, that is, you had an illness or injury before you joined the military and serving made it worse.
- You have an in-service disability claim, that is, you got sick or injured while serving in the military and can link such condition to your illness or injury
- You have a post-service disability, that is, disability related to your active-duty service that didn’t appear until after your retirement from active service.
How can I apply for VA Medical and Medicare Coverage as a Veteran?
Veterans who wish to apply for VA medical coverage can get that done online or apply through the U.S. Department of Veterans Affairs. Care for all disabilities related to your military service is free, regardless of your income.
To help facilitate this process, veterans will be required to have their discharge papers, most recent tax return, and social security numbers for themselves and any dependants. Also, you are required to have access to account numbers for currently held insurance (including Medicare and private Insurance)
If you are a Veteran/senior who is 65 and older, you can apply for Medicare on the U.S. Social Security website. Ensure to have your tax papers and their Social Security numbers in hand. Following up the VA application process, as well as how Medicare and VA benefits intersect can be somewhat complicated.
They are some resources that can help you learn about VA benefits. These resources include:
- Directory of Veterans Service Organisation (VSO)
- VSO Search by State
- National Veterans Foundation (free help with VA benefits)
- The Veterans Legion
- The Veterans Benefits Administration
- The Veterans of Foreign Wars
- Your states Department of Veteran’s Affairs
MEDICARE ADVANTAGE AND VA BENEFITS
VA benefits and Medicare Advantage do not actually work together – they are completely separate, but you can have both plans, Medicare does not pay for whatever care you get from a VA facility, rather Medicare only pays for care received at a Medicare-certified facility that provides Medicare coverage for all your healthcare needs. In other words, VA and Medicare are coverage do not overlap, that is, each function within its jurisdiction and does cover for the other. However, if the VA authorized an individual to receive a VA-approved treatment in a non-VA facility, VA and Medicare could contribute to the costs.
You can get a Medicare Advantage plan if you have VA benefits. MA plans can help reduce your out-of-pocket risk if you decide to visit a non-VA facility. Most Medicare Advantage plans have little or no additional cost, so it is best you go for such MA plans if you also enjoy VA benefits. You can also look for a zero premium policy and ensure you go for one that doesn’t include prescription drugs because your VA benefits will most likely provide coverage for that. People with Medicare are required to pay their Part B premium and the treatment they receive, which are a 20% copayment or coinsurance.
The benefits of a Medicare Advantage plan and that of a VA health plan depend specifically on your goals. If you feel dissatisfied with the care given at your local VA, for example, and would like more flexibility with providers and less waiting time, a Medicare Advantage plan might help you meet your intended healthcare needs. Consolidating your care in one place becomes the best option because having both plans may be beneficial for certain coverage.
Basically, VA benefits cover care provided mainly in VA medical facilities, VA outpatient clinics, and VA nursing homes. Veterans can thus afford to receive care at any VA facility. Health benefits include coverage for the following:
- Medical and mental healthcare (including substance abuse treatment
- Home healthcare
- Nursing home care
- Durable medical equipment (DME)
- Medicare-excluded items (such as over-the-counter medications and supplies, annual physical exams, hearing aids, and glasses under certain circumstances)
VA health benefits always provide primary coverage in VA facilities. If you have VA benefits and become eligible for Medicare, you may consider the benefits of both types of insurance and if you should enroll in Medicare Advantage now or delay enrollment, bearing in mind the potential consequences of such a decision.
Having a Medicare Advantage plan in addition to your VA benefits may be just what you need to get full coverage for your healthcare. This is because:
- Medicare advantage provides you access to a provider network including hospitals and physicians
- Some Medicare Advantage plans incorporate Prescription drug (Part D) benefits
- Many veterans do not have to pay for Medicare Part A, but do for Part B (MA plans may have a slight increase in premium – or no added cost at all)
- A Medicare Advantage plan will help reduce your out-of-pocket costs if you pay a visit to a non-VA facility for treatment.
MEDICARE ADVANTAGE AND TRICARE FOR LIFE
Tricare for life is a supplement plan for qualified military retirees (and their eligible dependents) who are enrolled in Medicare Advantage. You can have both Medicare Advantage plan and Tricare for Life provide coverage for your healthcare needs.
Tricare for life is open to the following group of people:
- Medicare-eligible uniformed services retirees aged 65 or older
- Their eligible family members and survivors
- Certain former spouses
- Anyone registered in the defense enrollment eligibility reporting system (DEERS)
- A medal of Honor recipient or eligible family member
Note that: To qualify for Tricare for Life benefits, you must be enrolled in Medicare Part A and Part B.
Medicare Advantage is an attractive plan for most Medicare beneficiaries with Tricare because MA plans offer extra benefits such as coverage for chiropractic, routine dental, hearing, and vision or free gym memberships. These services are not offered by Medicare Pars A and B, so Medicare Advantage plans provide the best opportunity for people with Tricare for life to get coverage at a very minimal cost. For example, there are many Tricare beneficiaries who enroll in Medicare Advantage just to get the Silver Sneakers to benefit, and it’s not outside their rights to do so.
If you are an inactive-duty Military member, the Medicare Advantage plan will function as your primary insurance and will pay first for covered medical expenses while Tricare for life will stand as secondary insurance to Medicare.
The TFL plan functions as a supplement to Medicare. If a TFL beneficiary visits a doctor, the doctor’s office files a claim with Medicare and forward all your medical bills. After Medicare Advantage processes the claim and pays its part of the bill, it will send the remaining part of the claim to TRICARE. TRICARE for life covers up for your healthcare expenses not paid for by your Medicare Advantage plans such as coinsurances, copayments, or deductibles.
Also, Tricare for life provides coverage for prescription drugs, so you do not need to enroll in a Medicare Advantage Prescription drug plan. Rather, you may need to enroll in a Medicare Advantage plan without prescription drug coverage which will require you to pay a $0 premium for the plan. However, if you decide later that you need prescription drug coverage, you won’t have to worry about any late penalty. Tricare drug coverage is creditable for part D, so there are no penalties.
What if certain services are neither covered for by TFL or Medicare Advantage?
There are certain services that are not medically necessary and may not be covered. Examples would be cosmetic surgeries for body augmentation, butt lift, and breast enhancement. In other instances, if your Medicare Advantage plan does not cover a particular service and Tricare for Life does, Tricare will pay its part of the expenses for the service. However, you will be responsible for the Tricare deductible and any copayment or coinsurance. Similarly, if Tricare does not cover a service that your Medicare Advantage plan covers, your MA plan will pay its part of the expenses for the service while you will be responsible for the Medicare Advantage deductible (if any) as well as any copayment or coinsurance.
As a Tricare beneficiary, it is important to consider the following factors before enrolling I a Medicare Advantage plan:
- Both Tricare for life and Medicare Advantage plans offer Prescription drug coverage. You may therefore decide to choose an MA plan that does not cover for prescription drug because the premiums may be lower or there may be no premiums at all.
- You may need to pay a copay whenever you visit an in-network doctor through an MA plan, though Tricare for Life may cover the cost.
- The list of in-network providers for an MA plan may be smaller compared to that of Tricare for Life or Originl Medicare.
TRICARE FOR LIFE ENROLLMENT
Intending enrollees do not need to go through any rigorous process to get enrolled in TFL. Once you are enrolled in Original Medicare and registered in DEERS, you are covered automatically. However, you must possess a valid military ID card which must be renewed after it expires on the first day of the month of your 65th birthday.
Once you are eligible for benefits, you will be automatically enrolled by the Social Security Administration (SSA). You can confirm your status by checking any SSA office nearest to you or by calling 800-772-1213
If you delay getting enrolled in Medicare or fail to pay your Medicare Part B premium, TFL will suspend your coverage until you re-enroll. Once that is done, you will automatically receive benefits over again.