How VA Benefits Work with Medicare

You may assume that veterans’ health care is 100 percent covered at any hospital, anywhere. And that all they have to do is present their Veterans Affairs card. Unfortunately, this isn’t the case.

With roughly 15.8 million veterans in our country, it’s become a pretty big misconception for agents and clients trying to navigate their health coverage. So, we’ll try and clear things up.

How VA Benefits Are Distributed

Individuals who served on active duty in the military and were discharged or released, for reasons other than dishonorable discharge, can apply for VA health benefits.

Eligible veterans are assigned to coverage based on a priority level of one through eight. The VA uses priority levels to balance the demand for VA health care enrollment resources.

An individuals’ priority level determines the priority of access to facilities and benefits, as well as copay amounts for things like inpatient hospital stays and medication.

For this reason, seniors who have low priority might not be getting their optimal options for care through the VA alone. That’s where Medicare comes in.

The Power of Two

Original Medicare creates a secondary option for clients who have VA benefits, giving them more flexibility in their health care options and possible cost savings.

When seniors turn 65, they are eligible to enroll for Part A, which covers hospitalization, as well as Part B, which covers doctors and outpatient services. This coverage allows them to see any provider accepting Medicare, so there’s no waiting for a pre-authorization to use a non-VA approved facility or other provider.

Original Medicare creates a secondary option for clients who have VA benefits.

VA benefits may deny coverage to some veterans, even in emergency situations, if care was at a non-VA approved facility. Medicare is an easy way to prevent this disaster.

When Should Veteran Clients Enroll in Medicare?

Your veteran clients should enroll when they are first eligible for Medicare benefits, which typically means when they turn 65.

Down the road, if your client is older than 65 and loses VA coverage or decides to enroll in Part A and B afterwards, he or she may have to pay a late enrollment penalty that will permanently increase their Part B premium for the rest of their life.

Encourage your clients to give themselves double protection and prevent any unnecessary expenses.

What About Medicare Part D?

VA drug coverage is considered creditable, which means it’s as good as or better than Medicare’s options. It also means your client doesn’t need to enroll in a Part D drug plan.

Should your client lose their VA coverage down the road and choose to enroll in a Part D drug plan, they will not be subject to a late enrollment penalty as long as they enroll within 63 days of losing their VA benefits.

One reason a client may benefit from both VA coverage and a Part D plan is if they move into a nursing home outside of the VA health system that provides them with medications. VA benefits only cover the drugs a beneficiary gets from a VA pharmacy, and Part D plans cover drugs within the plan’s network.

Cover Veterans with Medicare

Senior veterans should enroll in Medicare as soon as they become eligible to secure more comprehensive coverage and gain vaster options for treatment facilities.

Additionally, enrolling on time, they can avoid a lifelong Part B penalty and they can have a secondary source of health care coverage in case their VA benefits are ever reduced or removed.

Senior veterans should enroll in Medicare as soon as they’re eligible.

With that kind of coverage, the nation they once protected can offer them a nationwide network of doctors, facilities, and professionals ready to offer great care. As an agent, you can help veterans get this peace of mind. Show them the way to amplify their coverage and get the care they deserve.

How Does Medicare Work with VA Benefits?

There’s a good chance your veteran prospects and clients have questions about whether paying for Medicare benefits really makes sense for them. We have answers.

Q: When should my client enroll in Medicare, and what are the benefits?

A: By enrolling in Medicare when they’re eligible, your clients can get so much more from their health care and can receive care at more facilities. But it’s imperative that they enroll as soon as they’re able to in order to avoid any penalties. They can get Part A, which covers hospitalization, and Part B, for doctor visits and outpatient services.

The nice thing about being a vet with Medicare? They don’t need to enroll in Part D (prescription drug coverage), because their VA benefits already cover them in that area.

However, having that added protection of a Part D plan could provide them with the ability to use a local pharmacy and may provide additional savings on certain prescriptions.

Q: Which providers can my veteran client with Medicare go to?

A: They can use their Medicare benefits when seeing any civilian provider that accepts Medicare. Beneficiaries can use Medicare.gov to find physicians and other clinicians who accept Medicare.

Additionally, all enrolled veterans can use their VA benefits for health care received at any VA facility nationwide. Veterans can find nearby facilities using this locator at VA.gov.

In order to apply VA benefits to services, your client must go to a VA facility or have the VA authorize services in a non-VA facility. Similarly, Medicare won’t pay for any care you receive at a VA facility.

Q: Can my client also have a Medicare Advantage plan? What about Medicare Supplements?

A: Yes, your client can have a Medicare Advantage or Medicare Supplement plan in addition to their VA benefit/Medicare combination. It’s strongly suggested, however, that they have Medicare Parts A and B at the very least.

Something to consider: Medicare Supplements can be harder to obtain or more expensive the longer a client waits past their Initial Enrollment Period. If their VA benefits are reduced down the road, they may regret not purchasing a Medicare Supplement when first eligible.

Unfortunately, vets can’t walk into any facility and be 100 percent covered — not many people can. But by pairing VA Benefits with Medicare, they have significantly more options and coverage than if they didn’t.

At Ritter, we reccomend that agents stay in touch with every kind of client in their book of business. Register with Ritter to have access to top technology tools such as IntegrityCONNECT from Integrity to manage all your clients in one platform.