Medicare and Veterans

One in five Medicare-eligible adults in our country is a veteran. That’s 9.3 million Americans age 65 and older. Most veterans have different healthcare situations than their peers and are usually covered through one of three plans: CHAMPVA, TRICARE or benefits through the Veterans Administration with Medicare for additional services beyond those covered by VA. The following is a brief summary of each.

1. CHAMPVA Eligibility:
To be eligible for CHAMPVA, you cannot be eligible for TRICARE, and you must be in one of these categories:
i) The spouse or child of a Veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office.
ii) The surviving spouse or child of a Veteran who died from a VA-rated service-connected disability.
iii)The surviving spouse or child of a Veteran who was at the time death rated permanently and totally disabled from a service-connected disability.
iv)The surviving spouse or child of a military member who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).
Source: 052019 https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva_eligibility.asp
CHAMPVA is always the secondary payer to Medicare. If you are eligible for Medicare, at any age and for any reason, you must enroll in Medicare Part A and Medicare Part B to keep your CHAMPVA benefits.

2. TRICARE for Retired Service Members and Families
TRICARE is a health insurance program provided by the federal government to active duty and retired military personnel and their family members. There are many different TRICARE programs. TRICARE for Life (TFL), a program for Medicare-eligible military retirees and their dependents, acts as a supplement to Medicare. If you’re eligible for both TRICARE and Medicare Part A, then in most cases you must have Medicare Part B to keep TRICARE.
052019 Sources https://www.tricare.mil/Plans/Eligibility/MedicareEligible/Retiree_and_Family

TRICARE for Life (TFL) basics

3. Veterans NOT covered through CHAMP or TRICARE
Many veterans are ineligible for CHAMP or TRICARE benefits however ARE eligible for medical and prescription drug benefits through a local VA (Veterans Administration) facility.

Veterans who use the VA medical and prescription drug benefit still enroll in Medicare Parts A and B. Since the VA prescription drug benefit meets Medicare Part D prescription drug plan requirements, veterans using VA are not required to enroll in a separate drug plan.

Still, many veterans using the VA medical and prescription drug benefits choose to enroll in a Medicare Advantage plan for when they wish to use services outside of the VA system, such as seeking a second specialist opinion or simply a more convenient location.

These Medicare Advantage plans usually charge a monthly premium (in addition to the Medicare Part B premium) and include a Part D prescription drug benefit – paid for and unused!

I encourage these veterans to explore whether a MA-Only plan is available in the area. A MA-Only plan often includes the same benefits as a higher premium Medicare Advantage plan but without the prescription cost feature – and added premium.

Special Election Period

Special Election Period for veterans with drug coverage through Veterans Administration

Every Medicare beneficiary has the option to change their Part C or Part D coverage each January 1 through the Annual Enrollment Period which runs October 15 through December 7.

However, veterans using the VA system for Part D prescription drugs have an additional opportunity in what is called a Special Election Period (SEP). This allows a plan change outside of the normal annual period.

For more information on the MA-Only plan for veterans using the VA system, please contact Dan by email or call (518) 346-2115.

Or, schedule a no-obligation telephone consultation:

Medicare, Veterans, VA, Champ, Tricare, Medicare Advantage, MA Only, Prescription Drug Plan, Medigap, Part D, AARP, Schenectady, Albany, Saratoga, Amsterdam, Troy, New York, NY, United Healthcare, Humana,