Veterans, You Have Health Care Options!

October 6, 2016

 

 

Many Veterans do not realize they can take advantage of both Veterans Affairs benefits and Medicare benefits. While you can use both healthcare benefits as a Veteran, Medicare and VA benefits do not work together. With VA benefits, individuals must see VA providers and use VA facilities. If a Veteran prefers to see a physician or seek treatment outside of the VA all expenses will be out-of-pocket.

Medicare does not pay for services received at a VA facility and/or VA only providers. Medicare covers healthcare services received at facilities and/or providers accepting Medicare. Utilizing VA benefits and Medicare benefits gives Veterans a choice on where to go for care. 

Medicare Eligibility:

Under 65:

You have End Stage Renal Disease (ESRD)

You have received Social Security Disability Income (SSDI) payments for 24 months 

Age 65 and Older:

  •  U.S. citizen or a permanent legal resident (lived in US min 5yrs)

  • You or Spouse worked (usually; worked 10 yrs & earned 40 credits)

    • In 2016, you receive one credit for each $1,260 of earnings, up to the maximum of four credits per year.

Medicare Coverage Options (Brief Overview):

Original Medicare Part A & B; covers hospitalization and outpatient services. Beneficiaries are responsible for deductibles and co-insurance. There is no limit on out of pocket expenses.

Medicare Advantage Plans; offered through private insurance companies. May have monthly premiums. At a minimum must provide same coverage as Original Medicare. These plans usually PPO or HMO plans and offer more coverage, including lower or no deductibles and co-pays. And the plans have annual maximum out of pocket limits. They may include prescription coverage.

Medigap/Supplement Plans; offered through private insurance companies. Have monthly premiums. Also offer more coverage. They do not have networks. All facilities and providers accepting Medicare must accept Medigap/Supplement plans anywhere in the US. These plans pay secondary to Original Medicare and have no prescription coverage.

Stand-alone Prescription Plans; offered through private insurance companies. Have monthly premiums (unless qualify for subsidies) and co-pays/coinsurance for prescriptions. Co-pays/coinsurances vary by plan. NOTE: Generally private insurance prescription drug coverage is not needed as they are included in VA benefits.

 

Summary:

Choosing a Medicare Plan in addition to VA benefits provides greater flexibility and choices to enhance beneficiaries healthcare coverage.

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