Many Medicare-eligible veterans will benefit from enrolling in a Medicare Advantage plan in addition to taking advantage of the health care services they receive from the VA. Medicare Advantage plans are managed health coverage plans offered by private companies under contract with the Federal government, and offer broader coverage with extra benefits versus VA coverage alone.
If you are a veteran on VA health care, here are some reasons why you might want to enroll in Medicare when you become eligible, and then select a Medicare Advantage plan as well:
Effective, efficient and flexible emergency room and urgent care. Depending on your disability rating and priority group level, you may find that your emergency room and/or urgent care visit is not covered by the VA if you don't meet several very specific criteria for your visit. You also risk having your ambulance services not covered. This is because VA coverage pays for medical services if you go to a VA hospital or doctor but if for some reason you need to go elsewhere, it is possible that you will be required to pay the full cost yourself, even in emergencies. With Medicare, you're covered if you need to go to a non-VA provider. This is an especially important point to consider if you live some distance from the nearest VA facility.
Expanded and more flexible prescription drug coverage. If you have drug coverage through both the VA and a Medicare Advantage plan, you have the flexibility of using either one or the other. This means that in addition to getting drugs from the VA, you are able to get prescriptions from non-VA doctors and fill them at local retail pharmacies.
What's more, your Medicare Advantage plan might offer a different or more robust drug formulary, offering you the ability to get prescriptions you prefer but that aren't on the VA's formulary. You may even find that your co-pays for drugs on your Medicare Advantage plan are lower than those you have with the VA. And finally, if your income is under a specified threshold you can apply for low-cost drug coverage under Medicare's Extra Help program.
Lower medical co-payments and coinsurance. Depending on your priority rating, you may find you have co-pays to see primary care physicians and specialists with your VA coverage that are higher than those you would have with a Medicare Advantage plan. You will likely also have access to more doctors and specialists than you would have through the VA alone.
Extra benefits. For many vets, extra benefits tip the scale toward choosing enrollment in a Medicare Advantage plan. You can usually find more robust and comprehensive dental coverage than what the VA offers, along with coverage for vision services, glasses and even hearing aids. Medicare Advantage plans include memberships to health clubs or online fitness classes. Most Medicare Advantage plans also offer "Over the Counter" benefits, enabling you to get items like bandages, vitamins, aspirin, sunscreen and toothpaste on a periodic basis and at no cost to you.
Things to know. VA coverage and Medicare are completely separate. VA plans only cover care at VA facilities, and Medicare Advantage plans only cover care at Medicare assigned facilities. VA and Medicare coverage do not overlap, but there is no reason why you can't have both. Using one plan doesn't jeopardize your ability to use the other. In fact, having both gives you the broadest scope of options.
In order to enroll in a Medicare Advantage plan and take advantage of the benefits they offer, you'll first need to enroll in Medicare Parts A & B (also called Original Medicare). This is something that the VA strongly recommends all vets do anyway. You will want to enroll in Original Medicare during your initial initial enrollment period (usually the seven month window around your 65th birthday) because failure to do so may result in lifetime penalties. NOTE: Part A is usually premium free, whereas there is a premium for Part B ($148.50 for most people during 2021.)
After you've enrolled in Original Medicare, you can investigate your options in Medicare Advantage plans, which are available based on the county where you live. These plans have premiums ranging from $0 up to around $200 per month. Many vets will find that a no-premium or low-premium plan will give them many of the benefits they seek to work well in combination with their VA coverage.
An important word about TRICARE for Life. For those who are retired military, you may have been enrolled in TRICARE for Life upon turning 65. TRICARE for Life beneficiaries must be enrolled in Original Medicare; however the only charges for this program are your monthly Medicare Part B premiums. TRICARE for Life is robust, low cost coverage with few limitations on where health care can be received. Vets on this type of plan will want to avoid enrolling in any other Medicare coverage beyond Original Medicare in almost every circumstance.
In closing. If you are a veteran with VA health care coverage, you should enroll in Original Medicare, but you will also want to take a closer look at Medicare Advantage plans. These plans will broaden your coverage, give you more choice, possibly save you money and even mitigate the risk of expensive emergency care expenses. There are many choices available when choosing a Medicare Advantage plan, and considerations when choosing one include premium cost, extra benefits and drug coverage requirements just to name a few. Reach out to a licensed, independent agent who specializes in Medicare insurance for some help in decision making. There is no cost to you for their services, and you'll be securing a partner to help as you navigate future health care choices as well.