Answers about Medicare and VA benefits

With the Medicare open enrollment underway from Oct. 15 - Dec. 7, many veterans are asking if they are required to enroll in Medicare.

It is important for veterans to be able to make educated decisions about Medicare enrollment and their Veterans Administration benefits.

According to the National Council on Aging, there are many advantages to enrolling in Medicare even if you have other military health benefits. They note Medicare can add another layer of coverage, cost savings and convenience even if people already have VA benefits or TRICARE for Life.

Depending on how service members leave active duty, they may qualify for healthcare coverage either through the Department of Veterans Affairs (VA) or or TRICARE.

VA does not recommend veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care and strongly encourages those without employersponsored insurance to sign up for Medicare Parts A and B as soon as they qualify.

Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to enrollment priority groups based on a variety of eligibility factors, such as service-connection and income. There is no guarantee that in future years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups. This could leave veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage. For this reason, having a secondary source of coverage may be in veterans’ best interest.

Enrolling in both VA and Medicare can provide veterans flexibility. For example, veterans enrolled in both programs would have access to community physicians (under Medicare Part A or Part B) and can obtain prescription drugs not on the VA formulary if prescribed by community physicians and filled at their local retail pharmacies (under Medicare Part D).

And keeping your VA benefits in addition to Medicare means you can get coverage for services and items not covered by Medicare, such as hearing aids and over-the-counter medications.

It is not mandatory to enroll in Medicare at age 65 if you’re a veteran with VA benefits. However, if you choose not to sign up for Medicare, you won’t have coverage for services you get in facilities outside the VA health system.

In addition, if you don’t choose to enroll during your initial enrollment period you can face potentially having to wait to enroll during the open enrollment periods and could face penalties. The initial enrollment period is the seven-month window around your 65th birthday, or for those under 65 and found to have a disability, generally the month after a 24-month “waiting period.”

How does it work It is important to remember that VA benefits and Medicare are separate systems and not coordinated in any way. It is up to you to decide which benefits you want to use when receiving care.

In order to use VA benefits you must visit a VA doctor or facility or have reapproval for a non VA facility. To use Medicare benefits, you must receive care at a Medicare-authorized facility. Your VA benefits will not cover your copayments and other Medicare outof-pocket costs. The bottom line: If you have VA benefits and then qualify for Medicare, it’s important to weigh the coverages provided by both plans. Depending on your priority group, you may lack benefits for certain VA health services or have more out-of-pocket costs. Also, even if you’re satisfied with your current VA benefits, consider the fact that life changes. You might end up moving somewhere with less access to VA facilities, or decide you want to see a non-VA provider. Having Medicare can give you the added flexibility you need.

For those who retire from the military and are on TRICARE, coverage under traditional TRICARE ends when you become eligible for Medicare. In this case you will want to enroll in Medicare Parts A and B within three months of turning 65 to avoid any lapse in health care coverage.

Enrolling in Medicare does not mean you’ll lose out on TRICARE benefits completely. Instead, you’ll switch to TRICARE for Life. This change is 100% automatic, so there's no need to fill out any special paperwork. If you are listed as TRICARE-eligible in the Defense Enrollment Eligibility Reporting System (DEERS), your TRICARE for Life coverage should begin on the same day as your Medicare Parts A and B coverage.

TRICARE for Life serves as “wrap-around” coverage for your Medicare plan and acts much like supplemental plans offered by private insurance carriers. Essentially, it enhances your existing benefits by reducing or eliminating out-of-pocket costs for many treatments, such as deductibles, coinsurance, and copayments. It may also pay for certain services not covered under Medicare, such as health care coverage outside the U.S.

It's important to note that TRICARE for Life is tied to the individual person; it does not extend to family members. If you have family members not eligible for Medicare, they will still be covered under their regular TRICARE plan.

Taylor County Veterans Service Officer Sheila Sutton or Benefit Specialist Karyn Gebert in the veterans service office at the courthouse can help veterans with questions as they go through the process. Other local resources for those with questions include Gaul Sauerman at the Taylor County Commission on Aging.