Many folks who have served this great country receive healthcare benefits via the VA or TRICARE for Life (TFL). It is important for these individuals to understand how Medicare interacts with their current veteran benefits, below we will walk through this interaction and note how to navigate this situation if you are a veteran.
Medicare & VA waivers and non-waivers:
For those that elect to use TFL or the VA for their main source of medical benefits be it doctors office visits, surgeries and services, they must still enroll in Medicare Part B and pay their premium associated with it. Veteran benefits are not a valid waiver for Part B, so enrolling once eligible is essential in order to avoid late enrollment penalties. On the other hand, if you wish to use your VA benefits to receive prescription drug coverage you will be able to waive your Part D enrollment when eligible as the VA is in fact a valid waiver for Part D.
Medicare Advantage & VA/TFL:
The VA offers some great benefits for veterans, Tricare For Life is what many call "The Cadillac of Health Care Coverage", as it offers a ton for its beneficiaries. However, there are some advantages and one disadvantage of taking a Medicare Advantage plan and pairing it with VA or TFL benefits.
Positives:
If you are a healthy veteran with VA or TFL you may be a candidate for a MAPD plan as well. MAPD plans are popular among healthy individuals; veteran or not, due to the typical no plan premium associated with them, ancillary benefits offered (dental, vision, OTC), and in some cases the Part B giveback associated with select plans. As we already covered, VA/TFL is not a valid waiver for Part B, so taking a MAPD plan that offers a Part B giveback (sometimes up to $160/mo) can help to cut down that required premium payment associated with Part B. The additional benefits of vision, dental, hearing, OTC and fitness benefits can also provide more value for the veteran than what they are currently receiving from the VA. As a beneficiary of both the VA and a MAPD, you are able to use either network for services and prescription drug coverage.
Negatives:
As stated, pairing a MAPD plan with VA/TFL benefits only makes sense if you are a healthy veteran that does not utilize many medical benefits over the course of the year. Taking a MAPD while receiving VA benefits will place Medicare as your primary source of insurance when handling claims, VA will come secondary. This order of billing can cause a headache for veterans who utilize many medical benefits over the course of the year. You will have to utilize your MAPD network for services outside of the VA, anything that your MAPD plan does not cover in full you will receive a bill for claims wise, you will then need to forward the remaining charges to the VA or TFL for them to pick up your tab. Manually handling claims can be a lot if the beneficiary is in and out of the doctors office or hospital.
Conclusion:
Electing to take a MAPD plan while receiving benefits from the VA all depends on your healthcare situation, how often you use medical benefits, and what you value in your healthcare. There are positives and negatives associated with forgoing or taking a MAPD plan with the VA/TFL. It is best to reach out to a Poindexter representative to assess your situation and help you decide what may be best given your situation.
