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One thing I have learned working with Medicare is that veterans often have access to some of the best health care benefits available. But I have also seen people with VA benefits and/or TRICARE enrolled in Medicare coverage that doesn't work well with the benefits they already have, creating unnecessary costs and problems.
The first thing to understand is that VA health care and TRICARE are not the same, and your Medicare decisions will depend on which benefits you have.
If You Have VA Health Care
One of the most common questions I hear from veterans is:
“I already use the VA. Do I really need Medicare?”
VA health care and Medicare are separate systems. Medicare generally does not pay for care you receive at a VA facility, and VA health benefits generally do not work as secondary insurance when you choose to see a non-VA provider.
The VA itself encourages eligible veterans to enroll in Medicare.
This is directly from the VA website:
“We encourage you to sign up for Medicare as soon as you can for these reasons:
- Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from.
- Funding for VA health care could change in the future. We encourage you to sign up for every health care benefit that you’re eligible for so you have options if you need them.
- If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a penalty. This penalty gets bigger each year you delay signing up—and you’ll pay it every year for the rest of your life.”
For some veterans, receiving most or all of their health care through the VA works extremely well. Others want the flexibility to receive care outside the VA system too.
Maybe you live a long distance from a VA facility. Maybe you want the option to see a specialist closer to home. Maybe you travel frequently. Or maybe you simply want another option if your health care needs change.
Those are all things worth considering when deciding whether to enroll in Medicare Part B.
Be Careful About Delaying Medicare Part B
Medicare Part A is premium-free for most people because they or their spouse paid Medicare taxes while working. Part B has a monthly premium, so I completely understand why someone who already receives health care through the VA might wonder why they should pay for additional coverage.
The important thing is to think beyond what you need today.
VA health care generally does not protect you from the Medicare Part B late-enrollment penalty the way qualifying current employer coverage can.
If you decline Part B and decide you want it later, you may have to wait for an enrollment period and may have a late-enrollment penalty added to your Part B premium.
You may ultimately decide that delaying Part B makes sense for your situation, I just want that to be a decision you make because you understand the consequences—not because someone told you that having VA benefits means you don't need Medicare.
If You Have TRICARE for Life
TRICARE works very differently from VA health care.
When you become eligible for Medicare based on age, you generally need Medicare Parts A and B to have TRICARE for Life. There are exceptions to the Part B requirement in certain situations, so your individual eligibility should always be verified.
With TRICARE for Life, Medicare generally pays first for Medicare-covered services and TRICARE pays after Medicare.
Medicare Advantage
One of the most important things to understand is that you do not need a Medicare Advantage plan to have TRICARE for Life.
You can choose to enroll in one, but you don't have to.
Some people with TRICARE for Life choose to add a Medicare Advantage plan because it may provide additional benefits they value, such as dental, vision, fitness benefits, chiropractic coverage, or a reduction in the amount they pay toward their Part B premium.
Those additional benefits can be valuable, but the Medicare Advantage plan needs to work well with the TRICARE coverage you already have.
Medicare Supplement / Medigap
If you have TRICARE for Life, a Medicare Supplement is generally unnecessary.
TRICARE for Life already works with Original Medicare to cover much of the cost-sharing that a Medicare Supplement is designed to help with. You can have a Medicare Supplement, but paying an additional monthly premium for one may not make sense for you.
Prescription Drug Coverage
TRICARE for Life already includes prescription drug coverage through the TRICARE Pharmacy Program, so you do not need Medicare Part D just to have prescription coverage.
There are situations where Part D may be beneficial, but it should not be added automatically without first looking at your medications and how the Part D coverage will work with TRICARE.
I have seen people with TRICARE who were told they needed a Part D plan, only to discover that prescriptions they had been receiving at little or no cost through TRICARE now worked differently under their new coverage.
If you have TRICARE for Life and are considering Medicare Advantage, whether the plan includes Part D prescription coverage is an important part of the comparison. In some situations, a Medicare Advantage plan without Part D may work better alongside TRICARE's existing prescription coverage.
This is one of those areas where a small difference in the type of plan can make things better—or much worse.
More Benefits Don't Automatically Mean Better Coverage
This is probably the biggest thing I want veterans and military retirees to know.
Please don't change good coverage just because you received a phone call, saw a commercial, or saw an advertisement promising extra benefits or money back.
That doesn't mean Medicare Advantage plans are bad. There are absolutely times when adding one can provide valuable benefits or save you money.
But it needs to make sense for your situation.
Veterans and military retirees have earned valuable health care benefits. Medicare should work with those benefits, not create unnecessary costs or complications.
If you are approaching 65 and have VA benefits or TRICARE, I recommend starting the Medicare conversation at least three months before the month you turn 65.
That gives you time to understand what you need to enroll in, what you may want to enroll in, and—just as importantly—what you may not need.
If you are already on Medicare and aren't sure whether your current coverage works well alongside your VA or TRICARE benefits, it is worth reviewing that too.
There isn't one Medicare answer that is right for every veteran.
Sometimes the Best Advice Is to Leave Things Alone
No matter who you are, I think this is an important part of working with a Medicare broker.
My job isn't to find a reason to enroll every person I talk to in a new plan.
Sometimes I review someone's situation and the answer is simply:
“You already have really good coverage. I wouldn't change this.”
Other times, we find an option that adds benefits they need or want, gives them more flexibility, or saves them money.
The goal isn't to add more coverage. It's to make sure the coverage you have makes sense for you.
Sources
U.S. Department of Veterans Affairs, VA Health Care and Other Insurance (Read More)
TRICARE, Becoming Medicare-Eligible (Read More)
TRICARE, TRICARE For Life (Read More)
TRICARE, Medicare Part D and TRICARE (Read More)
