VA Benefits and Medicare Coverage be combined

Can VA benefits and Medicare coverage be combined?

If you have VA benefits, you can enroll in Medicare when you turn 65. The programs will work alongside each other. With VA benefits, you are restricted to VA hospitals or doctors approved by a VA doctor. Enrolling in Medicare allows you to use Medicare-approved hospitals and doctors.

With coverage from both organizations, you have broader options. The coverage does not coordinate. At each health appointment, only one coverage will apply. Care at a VA facility will be covered by VA benefits, and care at a non-VA facility will be covered by Medicare.

Benefits

One of the benefits of the additional coverage from Medicare is funding. VA benefits are divided up according to the priority group number. With the budget approved annually by Congress, it is potentially less stable to rely on.

You likely will not need a Medicare Part D prescription drug plan because the VA plan offers more generous benefits. A Medicare prescription drug plan can allow you to get drugs at non-VA facilities and get medicine from non-VA doctors. 

If you have TRICARE, you will have to enroll in Medicare Part A and Part B to keep your benefits. To have TRICARE For Life, you need to be enrolled in Part A and Part B.

If you have a low income, Medicare’s low-income subsidy for Part D is called Extra Help. There are three levels of Extra Help, based on monthly incomes and the worth of assets you own. The resources required for the first two levels are less than $9,360 for individuals and less than $14,800 for couples.

Levels of Extra Help

Level 1 of Extra Help covers the premium, deductible, and costs once drug totals exceed $9,038.7. For prescriptions at Level 1, you pay $1.30 for generic and $3.90 for name-brand. To qualify, your monthly income should be less than $1,083 for individuals and less than $1,457 for couples.

Level 2 also covers the premium, deductible, and costs once drug totals exceed $9,038.7. Generic prescriptions cost $3.60, and name-brand prescriptions cost $8.95. To qualify for Level 2, monthly income must be less than $1,457 for individuals and less than $1,960 for couples.

Level 3 of Extra Help is available to individuals with a monthly income less than $1,615 and less than $14,800 in assets; couples need less than $2,175 in monthly income and $29,160 in resources. Level 3 covers the premium based on a sliding scale. The Part D deductible is $89. You pay 15% for prescriptions (versus 25%), and after prescriptions total $9,038.7, you pay $3.60 for generic and $8.95 for name-brand prescriptions.

Recent Posts