Veterans Medicare benefits work the same way as anyone else’s Medicare benefits. Veterans can opt to get their care at VA facilities instead of civilian facilities though This gives them have more choices for care. A common question we get from these servicemen is whether they should also enroll in 1)Medicare and 2) Medicare supplemental coverage.
We STRONGLY recommend that you enroll in at least Medicare Parts A and B.
You may plan to get all your coverage at the VA. But what if VA funding changes down the line? What if there are not enough funds to provide healthcare for all the different VA enrollment priority groups? You would then need to enroll in Medicare but you’d be past your initial enrollment period and subject to significant penalties.
Once enrolled in Medicare, it’s up to you decide if you want a Medigap or Medicare Advantage plan in addition to your Medicare. However, you should consider it to save yourself time, hassle, and unexpected medical bills.
Medicare Supplement Plans for Veterans
My father is a Vietnam veteran, and he is also enrolled in Medicare Parts A and B and a supplement. That’s because I want him to have access to the best care and I want that care to be timely if needs it.
No one wants to wait months for care after receiving a serious diagnosis. Unfortunately, the VA has had some negative press regarding wait times in recent years. There are also financial concerns when it comes to emergency services, so that’s what we’ll explore in this post and examine a solution.
First let’s look at how VA coverage is assigned, and how it is separate from Medicare.
About VA Coverage and Medicare
Eligibility for VA health care coverage is based on several conditions. These include length of military service, income level, disabilities related to your service and the VA’s resources.
Those that qualify for coverage are given a priority level from 1 – 8 with 1 being the highest priority. Your priority level is what determines the type of healthcare benefits you will have access to. People assigned an 8 priority level get the slowest access and the least coverage, so these people have the most to gain by supplementing their Medicare benefits.
The VA website itself states that VA and Medicare are separate and generally do not coordinate coverage. If a person has a non-emergency situation, they can request that the VA authorize services in a non-VA hospital, but even if it is approved, VA insurance does not pay for all services.
Medicare’s website also has a similar disclaimer on its page about VA coverage.
Knowing that the two programs rarely coordinate, it’s important to consider what you might be faced with in an emergency situation, since these incidences generally are the most costly.
Over the years, we have helped many people find insurance, and we’ve seen some hiccups occur when emergency care is needed. If you have an accident or illness that requires emergency care, an ambulance is going to escort you to the nearest hospital, not to your VA clinic that may be an hour away.
Hospitals will often default to billing Medicare. If Medicare processes your claims, they will assign the regular Medicare cost-sharing to you. This means you are now responsible for paying the Medicare Part A hospital deductible of more than $1300, and 20% of the cost of services that fall under Part B. These include the cost of your ambulance ride, surgery costs, anesthesiology costs, and expensive diagnostic imaging tests like CT scans, among other things.
An objection that some will raise is that you can ask the VA to pay for you in an emergency situation, and that will work, if the hospital files the billing properly. What we have seen in practice over the years though is that the hospital will bill Medicare, and once Medicare has paid its 80% share, you are on the hook for the other 20%.
You can go back to the hospital and say “You billed this wrong- you should have billed the VA,” but the odds of the hospital will give Medicare all its money back and then rebill the VA and hope to get that payment are not good odds. Once the hospital has their money in hand, they are more motivated to just try and collect the other 20% from you. They have little motivation to straighten it out on your behalf.
Could you ultimately straighten this out? Perhaps, but it would take an enormous effort and you don’t know whether you will be in a well enough state to keep after it.
Real Life Scenarios
With thousands of policyholders, we get quite a lot of feedback from our clients about what issues and problems they run into out in the real world. In 2012, one client’s husband shared his story with us after this exact scenario above happened to him. He is making monthly payments toward a $10,000 bill.
Another veteran came to us looking to add new coverage after he also ended up in this situation. He explained that he approached the VA for help in a similar situation, and the VA wouldn’t even look at his bill after it had already been submitted to Medicare. He wasn’t even given the option to fight it. In addition, he shared that the hospital’s billing department told him they prefer not to bill the VA because they don’t like how long they have to wait for their payment.
VA Benefits and Medicare Advantage Plans
Many veterans don’t want to pay for a Medigap plan when they know they have the option to treat at the VA. So how do you protect yourself against this emergency scenario without breaking the bank? There are two pretty good options.
First, Medicare Advantage plans make a great inexpensive backup to your VA coverage. Medicare Advantage plans have lower premiums than Medigap. In some areas, you can even find plans with a $0 premium. You can treat at the VA just like you normally do, but in the event that you encounter an emergency like we have described above, you’ve got coverage for your treatment in a civilian hospital.
As with all Medicare Advantage plans, you will have some cost sharing. You may have a doctor copay or a hospital copay. Nonetheless, it will be far less than owing deductibles and 20% when you have only Original Medicare. These plans also have out of pocket maximum limits to cap from spending too much in one year.
Second, you might consider a High Deductible Medigap Plan F. This plan is very inexpensive but will kick in with comprehensive coverage to limit your Medicare spending after you meet a deductible. That deductible is $2480. In an emergency situation where you’re the 20% that you owe after Medicare pays is $10,000 or more, having a deductible to limit your spending to $2480 is terrific.
Part D for your Medications
Keep in mind though that Medicare supplement plans do not include Part D Drug coverage. You can purchase a Part D drug plan separately if you like. They are quite affordable.
Your other option is just to use the VA for your drug coverage. However, the VA will only fill medications prescribed by a VA doctor. Let’s say a civilian doctor prescribes you a medicine that you will need to take regularly. If you wish to fill this at the VA, you’ll need to schedule an appointment with a VA doctor to have him prescribe that medicine for you. The VA clinic won’t fill a medication for you if a VA doctor didn’t prescribe it.
Enrolling in a separate standalone drug plan can help you avoid this inconvenience. Of course, you would need to pay for that Part D drug plan. The choice is yours.
So what should you do? Ultimately you will need to decide if you can be content with possibility of waiting for care, and incurring the risk of Medicare spending if you encounter an emergency. There are not right or wrong answers. Only you can make that decision. Do your research before letting your Medigap or Medicare Advantage open enrollment window slip by.
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