Veterans Administration (VA) Coverage

Veterans Administration (VA) Coverage

1. Not all Veterans receive VA healthcare benefits:
2. Eligibility is based on the amount of service.

• NOTE: Veterans are not automatically enrolled.  must also apply for VA Healthcare benefits.  Therefore veterans should apply for VA healthcare if they think they may be eligible.

3. Many Veterans utilizing the VA will have copays and cost shares that vary based on their priority group.

·     Priority Group 1 Veterans have no out-of-pocket costs at the VA.

4. There is no premium for VA Healthcare.
5. VA coverage is creditable coverage for Medicare Part D.

·         What this means is that if a Veteran has had VA Healthcare since they turned 65 and decides to sign up for an MAPD or PDP plan they will not face a late enrollment penalty, however the VA can provide proof of creditable coverage in the form of a letter if needed.

6. VA Healthcare is not considered creditable for Medicare Part B.

• If a veteran declines Part B when they first become eligible, its possible they may be subject to the Part B Late enrollment penalty should they decide to enroll at a later date.

7. The Veterans Administration  (VA) cannot bill Medicare or Medicare Advantage plans for services received at the VA.

Tricare and Tricare for Life explained

1. What is the difference between TRICARE and TRICARE for Life (TFL)?

• TRICARE is available to active-duty military, National Guard, retirees, and their families. Tricare for life (TFL) is available to retirees who are enrolled in Medicare Parts A & B and now utilize TRICARE as secondary coverage to Medicare.

2. Who is eligible for TRICARE for Life (TFL)?

·         Tricare for life (TFL) is available to retired members of the military (generally those that served 20+ years), their spouses, and dependents who also have Medicare Parts A & B.

3. Do TRICARE beneficiaries need to enroll in Part A & B of Medicare when they become eligible?

·         When a TRICARE beneficiary becomes eligible for Medicare, they are required to take both Parts A & B of Medicare to continue using TRICARE and then transition to TRICARE for Life (TFL). When this happens Medicare will be the primary coverage and TRICARE will be secondary. They can see any provider who accepts Original Medicare and when the provider bills Medicare, Medicare will automatically send the remaining or excess  amount to Tricare for payment. They will have no out-of-pocket cost for services covered by Medicare and TRICARE.

4. Can a TFL beneficiary enroll in an Medicare Advantage Prescription Drug plan (MAPD)?

·         Tricare For life (TFL) beneficiaries already have creditable drug coverage. TFL drug coverage does not have a coverage gap and usually provides a more comprehensive alternative compared to an MAPD. Enrolling a TFL beneficiary into an Medicare Advantage Prescription Drug Plan (MAPD) will remove their TFL drug benefit.

5. Can a Tricare For Life (TFL) beneficiary enroll in an Medicare Advantage (MA)-only plan?

·         The MA-only plan will replace original Medicare and be their primary coverage to Tricare. The TFL member can go in or out of the network of the MA-only PPO plan, however, the cost associated with services needs to be in the form of a Copay or Co-insurance that is 20% or less to provide 100% coverage. Therefore Tricare For Life beneficiaries enrolling  in an Medicare Advantage (MA-only) plan can be a good option.

6. Can a TFL beneficiary enroll in a PDP plan?

·         Tricare Fore Life (TFL) beneficiaries already have creditable drug coverage. TFL drug coverage does not have a coverage gap and can normally provide a more comprehensive alternative compared to a PDP so this is usually not a good option.

7. Can a TFL beneficiary enroll in a Med Supp plan or any other coverage?

·         They could but there would be no benefit to doing this as Tricare for Life covers what a Med Supplan would have provided. 

9. Can a Tricare for Life beneficiary enroll in an MA-only plan to only use the additional benefits ( such as vision care, dental, OTC, giveback, etc..) and continue to use their original Medicare as they do that vary based on their priority group.

·         No. The TFL beneficiary would need to utilize the MA-only plan to see providers/doctors because they will no longer have original Medicare.

10. Do Medicare enrollment periods apply to TFL beneficiaries?

·         Yes, all enrollment periods Initial Enrollment Period (IEP), Initial Coverage Enrollment Period (ICEP), Annual Enrollment Period (AEP), Special Enrollment Period (SEP) apply to TFL beneficiaries.

11. Can Tricare beneficiaries enroll in an MAPD plan if they have (Low income supplemental) LIS?

• Yes, if the agent discloses the following options:

·         Option 1: The client keeps their Tricare drug benefit, and then enroll in an MA-only plan.

·         Option 2: Use LIS instead of Tricare drug benefit for a lower copay and larger drug formulary to have access to. In this case the insurance agent would have to explain to the client what the costs could be if the client were to lose LIS. The client would  no longer use their Tricare drug benefit.

CHAMPVA:

1. Who is eligible for CHAMPVA?

·         A spouse or dependent of a Veteran who is: Rated permanently and totally disabled due to a service-connected disability OR was rated permanently and totally disabled due to a service-connected condition at the time of death. Please note: *Spouses or dependents eligible for TRICARE are not eligible for CHAMPVA

2. Do CHAMPVA beneficiaries need to enroll in Parts A & B of Medicare when they become eligible?

·         Yes, when a CHAMPVA beneficiary becomes eligible for Medicare they are required to enroll in Parts A & B of Medicare to continue using CHAMPVA. Medicare will then be the primary coverage and CHAMPVA will be secondary.

3. Can a CHAMPVA and Medicare recipient sign up for an MA, MAPD, or PDP plan?

·         A client can sign up for a MA/MAPD plan. The client will have to notify CHAMPVA of their plan change and provide them with a copy of their plan’s evidence of coverage. The doctor will have to accept CHAMPVA and the plan.

4. Does the Doctor have to be in the network for CHAMPVA and the MA/MAPD plan?

·         Yes, the doctor will bill the carrier first (in/out of network) and then bill CHAMPVA without the client’s involvement

5. Can a CHAMPVA beneficiary enroll in a Med Supp plan?

·         A CHAMPVA member with original Medicare already has no out-of-pocket costs for services covered by Medicare and CHAMPVA. So there be little or no benefit to do this. 

6. Can a CHAMPVA for Life beneficiary enroll in a MA/MAPD plan to only use the additional benefits (dental, OTC, giveback, etc..) and continue to use their CHAMPVA as they do currently? Yes