July 18th, 2020

There are over 95 million veterans age 65+ and 1 in 5 of Medicare beneficiaries are veterans .  So I think this topic is extremely important..Yet many people are not being asked "Are you a veteran?"  This is an important question and if the insurance agent that your talking to doesn't ask, you need to let them know that you have coverage through the VA.  

So let's first talk about who is entitled to Veteran's benefits and how to go about getting benefits. The basic eligibility is going to be someone who served in the active military, naval, or air service.  
If you need to enroll, you can: 1. apply by phone at 1-877-222-VETS (8387) Monday through Friday, 2. apply in person at a VA healthcare facility or a VA regional office, 3. apply online at va.gov through electronic submission, or  4. download the form and mail to Health Eligibility Center,  ATTN Enrollment Eligibility Division, 2957 Clairmont Rd Suite 200, Atlanta, GA 30329-1647.    

After you apply, the VA will assign a priority level to you.  They will assign you a Priority level from 1 to 8 (with 8 having several subgroups).  The priority level that you are assigned will determine your VA health benefits.   It can be related to service disability, exposure to certain gases and chemicals, being a prisoner of war, a purple heart recipient, dates of service, income and many more factors.  

Now that we have discussed enrollment, let's dive into who should have additional insurance outside of VA benefits.  

VA benefits only provide coverage at a VA facility (except in emergency and other pre-approved situations) and Medicare won't pay for care you receive at the VA.  The coverage does not work together at all. 

The VA encourages veterans to get Part A and Part B as soon as they are entitled (source: va.gov/health-care/about-va-health-benefits-/VA-health-care-and-other-insurance).  All veteran's should get Part A as it is usually at no cost.   Having Part A will allow the veteran to get care at a non-VA hospital facility (but a deductible does apply under Part A).  If you have both Medicare and VA benefits, then you get to choose which coverage you would like to use.  This is really beneficial if you don't live near a VA facility, have a lower level priority group, or what more options for doctors and hospitals. 

Part B is another story.  Part B isn't absolutely necessary for all veteran's.  There are some that must have Part B to be entitled to services  (Tricare for Life and ChampVA for instance).  For those that get to choose, it is highly recommended that the veteran have Part B, especially if they are in the lower priority levels.  This is because funding can change and if the veteran were to lose their coverage, they could be faced with having to pay for care out-of-pocket, PLUS they would have a Part B late enrollment penalty (called and LEP) when signing up for Part B (for not signing up when first eligible for Medicare, since VA health benefits are not considered creditable coverage).  

Veteran's benefits are also not free to all priority groups.  There can be co-pays involved based on levels.  So looking at a Medicare supplement or Medicare Advantage plan could be something that you need to do to see if it makes sense for your situation.  When a veteran enrolls in a Medicare Advantage plan, they also have benefits that are not covered under the VA, such as basic dental (some veterans get free dental and vision, many do not), hearing, vision, transportation, over the counter medications, gym membership, and access to a nurse hotline 24/7 (benefits depending on the plan).  But a veteran must be careful when on Tricare for Life and VAChamp.   There are other considerations for Tricare for Life, but I will discuss those in an upcoming blog post.  

For Part D (prescription drug plans), once again the priority level comes into play.  Levels 2-8 do not get free prescriptions and are capped (limited) to $700 annually.   Assuming that the veteran is already on Part B, you just need to compare what you would pay out of pocket on a Medicare Part D prescription plan and what you would pay out of pocket on your VA benefits.  For veteran's that pay $5 or $8 on Tiers 1 and 2 on VA benefits, there are Part D plans that have Tier 1 and 2 at $0, so it may work for some veterans.  You just have to do a comparison to see if it is in the benefit of the veteran.  Medicare Part D plans can pay for prescriptions that are written by non-VA doctors.  However, if you decide to delay getting Part D, you can enroll later without a penalty, because VA prescription drug coverage is considered creditable coverage (unlike VA health coverage, which is not).  

So I recommend that you do a comparison of the coverage offered by Medicare and the coverage that you have as a veteran through the VA.  

Disclaimer:  I am not affiliated with Medicare, the VA, or any Federal or State agency.  I am a licensed insurance agent that can help you with Medicare Supplements, Medicare Advantage, or Part D prescription plans.