Veterans Benefits & Medicare – What You Need To Know
Veterans Benefits & Medicare
Medicare Part B & VA Coverage:
- You can have both Medicare and Veterans Affairs (VA) benefits. However, Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility.
- In order for Medicare to cover your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
- In order for your VA coverage to cover your care, you must generally receive health care services at a VA facility.
- Medicare Part B and VA Coverage:
Many veterans use their VA health benefits to get coverage for health care services and items not covered by Medicare, such as over-the-counter medications, annual physical exams, and hearing aids. However, you may want to consider enrolling into Medicare Part B (medical insurance), even if you have VA coverage. Part B may cover services you receive from Medicare-certified providers and provide you with medical coverage outside the VA health system. In addition, if you do not enroll into Part B when you are first eligible to do so, you will most likely incur a Part B premium penalty for each 12-month period you were without Medicare Part B coverage. In addition, you may also experience gaps in coverage.
Medicare Part D & VA Coverage:
- Some veterans only use their VA drug coverage to get their medications, since VA drug coverage may offer more generous prescription drug coverage than Medicare Part D, the Medicare prescription drug benefit. Since VA drug coverage is considered creditable, meaning it is as good as or better than the Medicare prescription drug benefit, you can delay enrolling into Medicare Part D without penalty. If you do lose VA drug coverage, make sure you enroll into a Part D plan within 63 days of losing your VA benefits.
- Note that although you can have both Medicare Part D and VA drug coverage, the two do not work together. VA benefits only cover the drugs you get from VA pharmacies and Part D plans usually only cover drugs you get from pharmacies that are within the plan’s network.
- You may want to join a Part D plan in certain situations. You may want to enroll in a plan if you move into a nursing home outside of the VA health system and need coverage for medications from the nursing home pharmacy. You may also want to enroll in a Part D plan if you qualify for Extra Help, the federal assistance program that helps people with Medicare afford their Part D drug costs.
If you have questions about VA benefits and coverage, contact the VA Health Administration Center at 1-800-733-8387 or 1-877-222-VETS (877-222-8387).
Drugs Not Covered By Medicare:
- Drugs for:
- Anorexia, weight loss or weight gain (except to treat physical wasting caused by AIDS, cancer or other diseases)
- Cosmetic purposes or hair growth
- Relief of the symptoms of colds, like a cough and stuffy nose
- Erectile dysfunction
- Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)
- Non-prescription drugs (over-the-counter drugs)
- Note: Prescription drugs used for the above conditions will not be covered by Medicare Part D. However, they may be covered if they are being prescribed to treat other conditions. For example, prescription medications for the relief of cold symptoms may be covered by Part D if prescribed to treat something other than a cold—such as shortness of breath from severe asthma—as long as they are approved by the United States Food and Drug Administration (FDA) for such treatment.
- If your doctor prescribes a non-cancer medication on the formulary for a reason other than the use approved by the United States Food and Drug Administration, your drug will probably not be covered unless the use is listed in one of three Medicare-approved drug compendia (medical encyclopedias of drug uses). For anti-cancer drugs, your drug plan should accept indications of drug use from additional compendia and other peer-review medical literature.
You may also receive a denial from your Part D plan stating that your drug does not meet DESI standards. The FDA’s Drug Efficacy Study Implementation (DESI) evaluates the effectiveness of those drugs that had been previously approved on safety grounds alone. Drugs that are found to be less than effective by DESI evaluation are excluded from coverage by Part D.
We offer plans to cover what Medicare Doesn’t
- We offer both Medicare Advantage & Medicare Supplements that cover the Medicare deductibles and co-pays.
- We represent the top Medicare insurance companies.
- Still Confused?
- Go to our website http://www.InsuredMeds.com
- or eMail me your question to InsuredMeds@gmail.com
- or call me at 845-380-5809