In this article
- 1 How does Medicare interact with my Veteran Benefits?
- 2 TRICARE
- 3 TRICARE plans
- 4 TRICARE for Life
- 5 TFL Enrollment
- 6 TFL & Medicare
- 7 TFL and other Health Insurance
- 8 TFL and Part D Prescription Drug Coverage
- 9 TFL and Medicare Advantage plan
- 10 CHAMPVA
- 11 CHAMPVA and Medicare
- 12 VA Benefits
- 13 Ready to Start the Conversation?
How does Medicare interact with my Veteran Benefits?
The interaction between veteran benefits & Medicare can be a complicated one, and it’s something that a lot of people do not fully understand. Lets start by looking at the different option available to veterans, who qualifies for which program, and the differences between each of them.
TRICARE
TRICARE is the health coverage program for active duty service members, the family members of active duty service members, National Guard & reserve members and their families, retirees and retiree family members and survivors.
TRICARE offers health care through military hospitals and clinics, as well as civilian health care professionals, pharmacies, and suppliers. Not all civilian medical facilities are in-network for TRICARE beneficiaries, so make sure to ask the provider if they accept TRICARE first.
With a few exceptions, TRICARE stops once you turn 65 and are eligible for Medicare Part A & Part B. Once it stops, coverage transitions to TRICARE For Life health coverage.
TRICARE plans
There are a number of TRICARE plans available, and eligibility for these plans depends on your situations. Like most other health care coverage plan, they each offer different benefits and cost sharing amounts. Examples of some of the plan types are TRICARE Prime and TRICARE Select. Make sure you talk to a specialist about your options and which plan is best for you and your family. While we can help guide you, this is not our area of expertise.
TRICARE for Life
TRICARE For Life (TFL) is a Medicare-wraparound coverage for people that are eligible for both TRICARE and have Medicare Part A & Part B. TFL coverage does not extend to family members.
Whereas Original Medicare provides coverage only in the US and US Territories, TFL can be used worldwide. It does behave a little bit differently in that when overseas TFL will become your primary insurance, as opposed to when in the US, TFL will be the secondary insurance. This can have an effect on the out of pocket cost associated with your care. Even though Medicare will not cover your care overseas, you still need to have Medicare Part B for TFL while out of the US.
TFL Enrollment
Enrollment in TFL is automatic if you have Medicare Part A and Part B. Coverage starts the first day your Medicare Part A and Part B are in effect.
Other than a few exceptions, once you turn 65, you MUST have Medicare Part A and Part B. If you do not enroll in Medicare Part A & Part B at 65, you run the risk of loosing coverage and having to pay more out of pocket. This is important because if you choose to keep working past 65, and your employer offers group insurance (offering you the option to delay your Part B enrollment), while you will still be covered by your group insurance, you will not have TFL coverage if you do not have Medicare Part B.
TFL & Medicare
Medicare and TFL do communicate. This is important because it determines who pays first and who pays second, unlike VA Benefits which do not communicate. Because of this communication, your out-of-pocket cost can be limited. Below is a chart showing where you cost may come from depending on what type of service you are receiving.
TFL and other Health Insurance
If you choose to continue your current health coverage from your employer while also paying your Medicare Part B premiums, TFL will become the tertiary insurance (meaning it will pay third). Depending on the type of other coverage you have, Medicare may pay first or second.
It is rare that keeping other health coverage is the best option along with Medicare Parts A & B and TFL as there are monthly premiums associated with each coverage type.
TFL and Part D Prescription Drug Coverage
Having TFL is one of the few times that you will NOT need to have a Part D prescription drug plan. With TFL, beneficiaries remain eligible for the TRICARE Pharmacy Program, which is creditable coverage.
If you do decide to enroll in Medicare Part D, either as a standalone or through a Medicare Advantage plan, you will need to follow the Part D plan’s rules for where to get prescriptions and the cost associated with those prescriptions.
There is almost never a benefit to enroll in a Medicare Part D plan if you have TFL as Medicare will remain the primary payer, which requires you to pay your plans premiums, deductibles, and copays first.
TFL and Medicare Advantage plan
Medicare Advantage plans are health insurance coverage plans offered by private companies contracted with Medicare. Coverage includes Part A and Part B. Some companies also include vision, dental, and prescription drug coverage. Some plans also offer a Part-B giveback, which helps to cover your monthly premium for your Medicare Part B.
If you choose to enroll in a Medicare Advantage plan, you will be required to get all nonemergency health services from that plan’s network or providers. You may pay copayments at the time of service. And you will need to file paper claims for TRICARE to reimburse you for TFL-covered services that you received.
Your Medicare Advantage plan does not always communicate with your TFL. Because of this, you normally need to pay upfront for your services and then file to be paid back for your expenses. For some people, the trade offs offered by Medicare Advantage make this worthwhile.
CHAMPVA
To be eligible for CHAMPVA you cannot qualify for TRICARE and at least one of the following needs to be true:
- You’re the spouse or child of a Veteran who’s been rated permanently and totally disabled for a service-connected disability by a VA regional office, or
- You’re the surviving spouse or child of a Veteran who died from a VA-rated service-connected disability, or
- You’re the surviving spouse or child of a Veteran who was at the time of death rated permanently and totally disabled from a service-connected disability, or
- You’re the surviving spouse or child of a service member who died in the line of duty, not due to misconduct (in most of these cases, family members qualify for TRICARE, not CHAMPVA).
CHAMPVA and Medicare
You will need to apply to receive CHAMPVA benefits through the VA. If you qualify for Medicare (for any reason), you will also need to submit a copy of your Medicare card. If you are older than 65 and do not qualify for Medicare, you will need to send documentation for the SSA confirming that you are ineligible for Medicare.
CHAMPVA will always be the secondary payer to Medicare. Similar to TFL, you must enroll in Medicare Part A & Part B to keep your CHAMPVA benefits once you turn 65.
A Part D drug plan is not required as, like TFL, you have creditable coverage and can receive your prescription drugs through the OptumRX network.
CHAMPVA interacts with Medicare Advantage plans in the same was that TLF does.
VA Benefits
Veteran Affairs benefits and Medicare are completely separate systems that do not communicate and do not work together or overlap.
With VA benefits, care occurs only at VA facilities. VA benefits will not cover Medicare out-of-pocket cost such as deductibles, copayments, or coinsurance.
If a VA beneficiary receives care at a Medicare-authorized facility (but not a VA authorized one), Medicare MAY step in an help cover cost not authorized by the VA.
Because these two systems are both very complex and do not communicate, it is best to talk to an expert. If you have questions regarding your VA coverage, contact the Veterans Affairs Monday through Friday 8am to 8pm EST at 877-222-8387.
If you like your VA coverage, I almost never recommend a Medicare plan. Because they do not communicate, there is little to no advantage.
Ready to Start the Conversation?
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