Asking the Right Questions: VA Benefits and Medicare
By: Dan Mangus, as featured by the National Association of Health Underwriters
Millions served in the military during Vietnam and are now eligible for Medicare. Add this number to the countless other veterans on Medicare or aging into Medicare and you have a significant population with unique situations.
When meeting with clients who are becoming or are eligible for Medicare, asking if they are a veteran is a crucial diagnostic question. Veteran benefits can have a profound impact on how a benefits package should be designed. Often there is an assumption that they have been made aware of the benefits they are eligible for. This, unfortunately, is not the case in many situations because no two veterans are the same. Establishing an understanding of how serving in the military impacts access to and cost of care is invaluable.
Let’s examine veteran classifications that will guide your recommendations while building a comprehensive benefits package. If the individual indicates that they are a veteran, you will then need to find out how they may be receiving veteran benefits.
The next question should be: “Did you retire from the military with Tricare for Life (TFL)?”
No, I didn’t retire from the military:
If the veteran did not retire with TFL, they are more than likely eligible for Veterans Administration benefits.
To receive benefits under the VA Medical Benefits Package, you must enroll in the VA health system and go to VA facilities or VA approved providers.
When you apply for VA healthcare, you are assigned to one of eight priority groups. Your priority group may impact:
- how soon you are signed up for healthcare benefits
- and how much (if anything) you’ll have to pay toward the cost of your care
Priority group are based on:
- your military service history
- your disability rating
- your income level
- whether or not you qualify for Medicaid
- and other benefits you may be receiving (like VA pension benefits)
Veterans with service-connected disabilities are assigned the highest priority, and the lowest priority is assigned to veterans who earn a greater income and who don’t have any service-connected disabilities qualifying them for disability compensation.
Utilizing the VA healthcare system does not require Medicare Part B. However, if services are ever received outside of the veteran healthcare system, they are not covered by the VA. Under Medicare Part B, VA healthcare is NOT creditable coverage. Creditable coverage under Medicare Part B can only be provided through an employer. Therefore it is usually recommended for an individual to elect Part B as soon as they become eligible for it since later enrollment would incur late-enrollment penalties.
If you have other private health insurance, including a Medicare supplement policy, the VA is required by law to bill your insurance carrier when you receive care for non-service-connected conditions.
Many veterans elect Medicare Advantage plans to replace original Medicare since it gives them expanded access to providers outside the VA system. Often they select MAPD plans since they expand access to coverage to civilian pharmacies as well. It is important to note that adding a Medicare Advantage plan or a Medicare supplement does not impact VA coverage.
VA drug coverage is considered credible coverage for Medicare Part D purposes. A veteran may prevent the late-enrollment penalty for Medicare Part D by reporting VA healthcare enrollment.
Yes, I did retire from the military:
If the individual did retire from the military with Tricare for Life, it presents another unique set of opportunities.
You may qualify for US military retirement if you:
- served on active duty in the U.S. Army, Navy, Air Force or Marine Corps for a period of 20 years or more
- or retired medically from the Army, Navy, Air Force or Marine Corps.
Note: Eligibility requirements for reservists are slightly different.
TFL provides expanded medical coverage to Medicare-eligible (whether due to a disability or when you turn 65) uniformed services retirees, to their eligible family members and survivors, and certain former spouses. You must have Medicare Part A and Medicare Part B to get TFL benefits. Although it requires Medicare Part A and Part B, it does not require Part D.
If you have Medicare and TFL, Medicare is primary and TFL is the secondary insurer for services covered by both plans.
Although it limits providers to a network, many veterans eligible for TFL replace their original Medicare with a Medicare Advantage plan. By utilizing a Medicare Advantage plan, veterans would expand the supplementary benefits they have access to. Since having a Medicare part D plan can complicate prescription drug claims, it is usually recommended to utilize a Medicare Advantage-only plan vs. a Medicare Advantage Prescription Drug Plan. Due to this opportunity, many of the large carriers have greatly expanded their MA-only product offerings for veterans in 2021.
Having access to these and other veteran benefits can help your clients receive much-needed assistance. This extends to their widows and widowers as well. Many surviving spouses have received benefits for items like extended care long after the death of their deceased veteran spouse.