Medicare and Veterans
You served in our military and as we all should be saying, “Thank you for that.”
Because you served in the military you are now entitled to the BEST OF BOTH WORLDS when it comes to your Medical coverage: You can take the best of Veteran’s coverage whether it’s through Veterans Administration, Tricare for Life, or through both; and combine veteran’s benefits with the best that comes from Medicare as well.
After all, YOU PAID FOR BOTH, all along. You paid for your veteran’s benefits by serving when you could have been following other pursuits. But, you also paid into Medicare, doing so a little bit from each pay check for the last 40 years or so. So why shouldn’t you benefit from Medicare, and what you contributed into the Medicare fund, as well?
That been said, let’s cover the two medical coverage plans that veterans may be eligible for: Tricare for Life and VA benefits. We’ll next look at how each of these can coordinate beautifully with Medicare like a beach chair coordinates with the beach.
TRICARE FOR LIFE
If you are eligible for Tricare for Life you probably know exactly what it is. But just the same, let’s review. Once someone who has Tricare for Life (TFL) becomes eligible for Medicare, Tricare For Life and Medicare form a kind of a partnership. In this arrangement Medicare becomes the primary payer for Part A and Part B and pays the first 80% of medical costs. Tricare for Life becomes the secondary payer and steps in and pays the other 20%. When you go to a doctor or hospital they understand this arrangement. They bill Medicare 80% and TFL the rest.
Think of it this way: Tricare for Life is just like a Medigap supplement that picks up all of the rest of your medical costs which Medicare doesn’t pay (just like Medigap Plan F does).
1. You get to see any doctor or go to any medical facility anywhere in the USA that takes Medicare. You can also usually use VA facilities, if you choose to, as well.
2. Because this is Original Medicare, you do not need a referral to see specialists.
The beautiful thing is you get the 20% Tricare for Life portion of your coverage for free. This is a sweet deal compared to those who didn’t serve in the military. Non-veterans need to buy a Medigap supplement while you don’t. Their supplement will cost them $100-$200 a month and will continue to go up and up in cost each year. On the other hand, your Tricare for Life portion will cost you nothing. Nothing will continue to remain nothing each year.
The Tricare For Life Kicker: 100% Drug Coverage!
We hope you are taking no pills at all. But, of course, that is not most people’s reality especially at age 65 and older. Many people are taking several prescriptions and some drugs can be very expensive. People who aren’t veterans have to worry about copays and coverage gaps and what is or isn’t in formulary. BUT NOT YOU. Being TFL, Tricare likely picks up 100% of your prescription drug costs.
This is an amazing benefit. In looking at your Medicare Advantage options in the next section, your 100% prescription drug coverage with TFL is not something you’ll want to trade in or give up.
Tricare For Life: Your Two Choices
You have two options that are well worth exploring: Tricare for Life by itself and Tricare for Life combined with a Medicare Advantage plan.
Let’s look option one: Tricare for Life alone. With this option Medicare will pay first and then Tricare for Life will pick up 100% of your medical costs and 100% of your prescription drug costs that Medicare doesn’t. So how do you beat 100 percent?
This is the very reason why so many veterans stop right there and don’t even consider Option Two of signing up for a Medicare Advantage plan. This is too bad, because for many Tricare for Life eligible veterans, Medicare Advantage and TFL together is like having your cake and eating it too.
Tricare For Life and Medicare Advantage
Let’s start by clearing up a myth. If you sign up for a Medicare Advantage plan this in no way eliminates or negatively impacts your Tricare for Life benefits. This is true so long as you sign up for a Medicare Advantage plan that does not include prescription drug coverage. In most locations there are several Medicare Advantage plans that don’t include drug coverage. These plans are specifically geared to work in conjunction with Tricare for Life or VA users because veterans will continue to get their drugs with no copays through their Tricare for Life or VA benefits.
IMPORTANT NOTE: You do not want to sign up for a Medicare Advantage plan that does include prescription drug coverage. This would set you up for having to get drug copayments reimbursed by TFL. This is a needless hassle when you can get 100% drug payments from Tricare for Life without the need for submitting paperwork for a reimbursement.
Let’s now clear up a second myth. If you have both Tricare for Life and a Medicare Advantage plan then both will coordinate together just fine, much as TFL does with regular Medicare. You should not have to pay any out-of-pocket costs or have to seek reimbursements from TFL. Tricare for Life will pick up your Part A and Part B copayments eliminating any out-of-pocket costs. Once again, this is identical to how TFL coordinates with regular Medicare.
So why would you want a Medicare Advantage plan in addition to a Tricare for Life Plan? Let’s examine the “Having Your Cake” while eating it too benefits:
REASON ONE: Medicare Advantage plans are usually premium free and so you likely won’t be paying anything for the extra benefits you’ll be getting. This means more coverage for you at no cost.
REASON TWO: Medicare Advantage plans usually offer additional benefits that you don’t get with regular Medicare, most especially for dental, vision and hearing. These benefits are included free of cost. For instance, most plans include free preventative dental and may also include $1,000 or more that you can use for any dental purposes. Most plans also include an allowance for eye glasses and a contribution for hearing aids.
REASON THREE: Medicare Advantage plans usually offer other perks. For instance, most plans have an allowance of $150 to $300 or more a year to buy over-the-counter medicines, vitamins and other medical supplies. Almost all plans offer Silver Sneakers or the equivalent which lets you join as many gyms as you want to join for free. Other perks include free meals after hospital stays and some plans offer added benefits such as for routine chiropractic, podiatry and even acupuncture.
REASON FOUR: There may be a plan available that will pay part of your Part B costs each month, saving you that money of paying it yourself.
Why You Might Not Want To Have A Medicare Advantage Plan
There could be good reasons to stick with having just Tricare for Life combined with Medicare and forgoing a Medicare Advantage plan. The main reason is that with some Medicare Advantage plans you will be locked into their medical network and because your Medicare Advantage plan will be the primary payer, and TFL secondary, you could lose the ability to see any doctor you want or the ability to see specialists without a referral.
On the other side of that coin, many Medicare Advantage plans that do not include prescription drug coverage are PPOs. A PPO gives you the ability to see doctors and use facilities outside of their network. With a PPO you also won’t need a referral to see a specialist. With a PPO you could be gaining considerably greater benefits without giving up any of the freedoms you enjoy with having Tricare for Life alone.
Let Us Help You Compare
We will be happy to go over the specific plan options with you so you can see what you might gain with a Medicare Advantage plan in coordination with Tricare For Life.
MEDICARE AND VETERANS ADMINISTRATION
When you turn 65, whether the VA sends you a Happy Birthday card or not, nothing really changes so far as the VA is concerned. You can still continue to get medical coverage through a VA facility and continue to get your prescription drugs through the VA as well.
Here is what does change: You are also now entitled to Medicare! After all, you paid into Medicare for all of these years so you get what is yours the same as everyone else who paid in, does. This means you will no longer be restricted to just using just VA facilities for your medical needs. For this reason alone, most veterans sign up for Medicare and take out both Part A as well as Part B.
This gives you the same options as anyone else signing up for Medicare has, with one very important additional one. Because you will probably have your prescription drug coverage through your VA benefits, the same as you have prior to Medicare, you won’t need prescription drug coverage through a Medicare Advantage plan. Or through a stand-alone Prescription Drug Plan if you opt for Original Medicare.
IMPORTANT TO NOTE: Unlike with Tricare for Life, Medicare and VA do not coordinate benefits. Each one stands on its own. This way you use the benefits from Veteran’s Administration or Medicare, whichever one serves your purposes the best in each situation.
If You Choose Original Medicare
All you will need to pay for is your Medigap supplement, most probably Plan G. You will not need to sign up or pay for a stand-alone Prescription Drug Plan providing that you get your drugs through the VA. Your Plan G, combined with Medicare, will pay 100% of your medical costs after you pay the $203 annual deductible. You will be able to see any doctor that takes Medicare anywhere in the USA and be able to see specialists without a referral.
If You Choose Medicare Advantage
Because your prescription drug coverage will likely be better through the VA, you will be able to pick a Medicare Advantage plan that does not include prescription drug coverage. You can still choose a Medicare Advantage plan that does include drug coverage but doing so could limit your ability to get your prescriptions filled through the VA.
As we discussed in the section on Tricare for Life, there are many pluses that you will get with a Medicare Advantage plan including the potential of having a portion of your Part B payment paid by the plan. We would be happy to review the plan choices and benefits with you.