Open Enrollment 2020: How Veterans Can Best Maximize Their Benefits

Dear Rune,

I am a veteran who wants to add Medicare Advantage benefits during open enrollment this year. I have a few questions about my veterans benefits and Medicare plans, and I’m hoping you can help. First, can Medicare Advantage and VA benefits work together? Also, are there any specific Medicare Advantage plans for veterans? Lastly, could a Medicare Advantage plan work with my VA prescription drug coverage?

Thanks for your help!

Max Emize-Bennafitz

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Dear Max,

The Medicare Annual Election Period – when people can make changes to their Medicare plans – is open now through Dec. 7, 2019. If you’ve been thinking about adding Medicare Advantage benefits to your health coverage, now is the time to take action!

Military veterans often have questions about how Medicare and Veterans Affairs (VA) benefits differ and how they work best with VA benefits. It’s important that you understand how the plans complement each other so you can choose the best plan for you and ensure you maximize health benefits available.

Here are the answers to your questions:

Can Medicare Advantage and VA benefits work together?

Yes! Many Medicare Advantage plans complement existing VA benefits and could be a good fit if you would like to enhance current benefits and coverage. Enrolling in a Medicare Advantage plan may provide access to additional services and benefits, such as urgent care and dental coverage, which do not interfere with VA benefits for prescription drugs and primary care. Each time you receive care you will need to choose whether to use your VA benefits or your Medicare Advantage plan.

Are there any specific Medicare Advantage plans for veterans?

While Medicare Advantage plans are available to anyone eligible for Medicare, certain Medicare Advantage plans work to complement VA coverage. They may offer access to a broader network including access to urgent care and non-VA facilities, which can be advantageous for veterans if they need to travel far to receive care at a VA facility or experience long wait times. The MISSION Act is supposed to alleviate these issues, but it’s still in progress. Read Mr. Farr’s article from today for more details.

My understanding is that the best health coverage possible is traditional Medicare coupled with Tricare for Life (TFL). TFL is Medicare wraparound coverage for Tricare beneficiaries who have Medicare Part A and Medicare Part B, regardless of age or place of residence. With TFL, you have the freedom to seek care from any Medicare-participating or nonparticipating provider, or at a military hospital or clinic on a space-available basis. Enrollment is not required, but you must pay Medicare Part B premiums.

Who is Eligible for TFL?

TRICARE is a health program for:

  • Uniformed Service members and their families,
  • National Guard/Reserve members. Includes members of the:
    • Army National Guard;
    • Army Reserve;
    • Navy Reserve;
    • Marine Corps Reserve;
    • Air National Guard;
    • Air Force Reserve;
    • U.S. Coast Guard Reserve and their families,
  • Survivors,
  • Former spouses,
  • Medal of Honor recipients and their families, and
  • Others registered in the Defense Enrollment Eligibility Reporting System (DEERS).

Click here for more details about eligibility.

How it Works

  • You may visit any authorized provider.
  • Your provider files your claims with Medicare.
  • Medicare pays its portion and sends the claim to the Tricare For Life claims processor.
  • Tricare For Life then pays the provider directly for Tricare-covered services.
  • You can get care at military hospitals and clinics, but only on a space-available basis.

What You Pay

  • You don’t pay any enrollment fees, but you must pay Medicare Part B monthly premiums. Your Part B premium is based on your income.
  • You’ll pay nothing out of pocket for services covered by both Medicare and Tricare.
  • For medical procedures covered by Medicare but not Tricare (e.g. chiropractic services) you will be responsible for Medicare deductibles and cost shares.
  • For medical procedures covered by Tricare but not Medicare you are responsible for any TFL deductibles and cost shares
  • For medical procedures not covered by either Tricare or Medicare (e.g. cosmetic surgery) you are responsible for the entire amount.

For more information please visit the Tricare For Life website.

How could a Medicare Advantage plan work with my VA prescription drug coverage?

Typically, VA prescription drug benefits will serve as your primary prescription drug coverage when you add a Medicare Advantage plan that does not include prescription drug coverage. Some Medicare Advantage plans also include Part D prescription drug coverage, which may help cover medications from non-VA doctors. You can also fill these prescriptions at your local pharmacy instead of through the VA mail-order service.

If you are enrolled in any Tricare health plan (as described above) you are automatically enrolled in a pharmacy program. There are 2 different pharmacy programs:

  • Tricare Pharmacy Program – The Tricare Pharmacy Program provides the prescription drugs you need, when you need them, in a safe, easy, and cost-effective manner.
  • Tricare Maintenance Medications Program – All persons taking select maintenance medications must receive refills via TRICARE Pharmacy Home Delivery or use a military pharmacy instead of using retail pharmacies.

Be sure to use the Medicare Plan Finder for more details about different Medicare Advantage Plans.

Hope this helps!
Rune

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