-
No, Medicare’s prescription drug coverage is completely voluntary.
Return to the Top of the Page
-
Yes, continuous enrollment in the VA health care system provides you with “creditable coverage” needed for the purposes of the Medicare prescription drug program (“Medicare Part D”).
Return to the Top of the Page
-
A spouse of an enrolled veteran can obtain VA benefits only if the spouse is a qualified veteran herself or himself. A spouse must determine whether enrollment in a Medicare Prescription Drug plan is a good idea without regard to the enrolled veteran’s status. Spouses covered by CHAMPVA should contact CHAMPVA for information at 800-733-8387 or visit their web site at http://www.va.gov/hac/forbeneficiaries/.
Return to the Top of the Page
-
Most veterans are currently charged $8 for each 30-day or less supply of medication provided by VA for treatment of conditions that are not service-connected. For veterans enrolled in Priority Groups 2 through 6, the maximum copay for medications that will be charged in calendar year 2009 is $960.
There are no copay caps for veterans in Priority Group 7 and 8. Also, VA does not have annual deductible requirements.
Return to the Top of the Page
-
The Medicare copay may vary by plan. The Medicare copay will be for each prescription, whether it is for a 30, 60, or 90 day supply of medication. If the beneficiary does not have Medicare's extra help for low-income individuals, the cost sharing for a prescription will vary according to the selected drug plan. For more information, Medicare provides basic information at http://www.medicare.gov/pdp-basic-information.asp.
Return to the Top of the Page
-
Medicare provides extra help to cover your prescription drug plan expenses if your income and resources are below established levels. For more information or to apply for extra help, contact Social Security at 800-772-1213 or apply online at www.socialsecurity.gov.
Return to the Top of the Page
-
Yes, all annual medical out of pocket expenses are deductible for purposes of VA means test (subject to those aggregate expenses that exceed 5% of VA’s applicable maximum pension rate).
Return to the Top of the Page
-
No, by law VA does not bill Medicare.
Return to the Top of the Page
-
No, VA health care and prescriptions benefits are separate and distinct from Medicare prescription drug plan requirements.
Return to the Top of the Page
-
A veteran who is or who becomes a patient or inmate in an institution of another government agency (for example, a state veterans home, a state mental institution, a jail, or a corrections facility), may not have creditable coverage from VA while in that institution. Veterans who are unsure whether this may apply to them should contact the institution where they reside, the VA Health Resource Center at 1 877-222-VETS (8387), or their local VA medical facility.
Return to the Top of the Page
-
Although VA has no plans to further restrict enrollment, if this happens, the veteran would be able to join a Medicare plan without penalty if he/she signs up within 63 days of loss of such enrollment status.
Return to the Top of the Page
-
Although VA is not enrolling any new veterans in Priority Group 8, VA has never used the enrollment process to cut-off or disenroll current enrollees. Depending on available funds, the cut-off point for enrollment may change in the future. If such an enrollment decision is made in the future, the veteran would be able to join a Medicare plan without penalty is he or she signs up within 63 days of losing enrollment.
Return to the Top of the Page
-
For this information, please call 800-733-8387or visit http://www.va.gov/hac/forbeneficiaries/
Return to the Top of the Page
-
Remember, the VA medical benefits program is separate from Medicare. Veterans may be enrolled in both programs but the enrollment process (and the eligibility criteria) is distinct for each.
Return to the Top of the Page
-
The Medicare program is divided by types of care or service: inpatient ("Medicare Part A"), outpatient ("Medicare Part B"), and prescription drug ("Medicare Part D"); seniors can decide in which "parts" of Medicare they wish to participate. VA offers a comprehensive medical benefits program that does not distinguish among the types of care or services received; generally veterans who are enrolled in VA health care are eligible for the entire medical benefits package (including prescription drugs), however, some veterans may be subject to a copayment for some care or medications received.
Return to the Top of the Page
-
VA does not recommend that veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care. Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to priority levels based on a variety of eligibility factors, such as service-connection and income. There is no guarantee that in subsequent years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment Priority Groups. This could leave veterans, especially those enrolled in one of the lower Priority Groups, with no access to VA health care coverage. For this reason, having a secondary source of coverage may be in a veteran’s best interest.
In addition, a veteran may want to consider the flexibility afforded by enrolling in both VA and Medicare. For example, veterans enrolled in both programs would have access to non-VA physicians (under Medicare Part A or Part B) or may obtain prescription drugs that are not on the VA formulary if prescribed by non-VA physicians and filled at their local retail pharmacies (under Medicare Part D).
Veterans should also be mindful of the late enrollment penalties in Medicare Part B and Part D that are imposed on those who do not enroll in Medicare during their initial enrollment period. VA health care is recognized as creditable coverage for Medicare Part D (prescription drug program) but it is NOT creditable coverage for Part B (outpatient health care, including doctors’ fees). So although a veteran may avoid the late enrollment penalty for Part D by citing VA health care enrollment, that enrollment would not help them avoid the late enrollment penalty for Part B.
Return to the Top of the Page
-
Not for prescription drug coverage. Veterans can delay enrollment in Medicare Part D (prescription drugs) without penalty if they are enrolled in a prescription drug plan that provides a benefit at least as good as that offered by Medicare. The prescription drug benefit in the VA medical benefits program is at least as good as that offered by Medicare. However, Veterans could be subject to a penalty for enrolling "late" for Medicare Part B, even if they are enrolled in VA health care because VA health care is NOT creditable coverage for Medicare Part B. In addition, "late" enrollment in Medicare may only be allowed at certain times (like the beginning or end of the year) and individuals who choose not to enroll when they are first eligible may be left without access to health care until they can enroll in Medicare.
Return to the Top of the Page
-
Veterans should take time to understand their options under the Medicare program. They should read carefully all information received from Medicare or the Social Security Administration-action may be required. For example, seniors are required to sign and return a card if they choose NOT to enroll in Medicare Part B. Failure to return the card could result in automatic enrollment and deduction of the Medicare Part B premium from the beneficiary’s Social Security check. Conversely, without some action, a senior would not be automatically enrolled in the prescription drug coverage under Medicare Part D.
Medicare also suggests some “Things to Consider” about enrollment on their website: http://www.medicare.gov/pdp-things-to-consider.asp.
Return to the Top of the Page
