Information for Veterans About the Medicare Prescription Drug Program (Medicare Part D)
The Department of Veterans Affairs (VA) administers the nation’s largest health care system. Many of the veterans enrolled in the VA medical benefits package are also eligible or may become eligible for enrollment in the Medicare program. Because many veterans have questions about Medicare’s prescription drug program (Medicare Part D), VA offers the following information about this program and its impact on veterans.
Prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium. VA has determined that its prescription drug coverage for veterans enrolled in the VA medical benefits package is at least as good as the standard Medicare prescription drug coverage benefit, meaning that enrollment in VA health care provides veterans with “creditable coverage” for Medicare Part D purposes.
Veterans eligible for Medicare can enroll in a Medicare prescription drug plan during their “initial enrollment period.” Medicare will tell you when you are eligible to enroll. Those who choose not to enroll during their initial enrollment period may be able to enroll during the annual enrollment period available each year, from November 15th through December 31st. Although some people who choose to enroll later may be subject to a penalty, veterans may usually avoid the penalty because VA enrollment provides “creditable coverage” as long as they were enrolled in VA health care from the time they were first eligible to enroll in Medicare.
Veterans should remember that in addition to prescription drugs, VA’s Medical Benefits Package provides a full range of health care benefits. Veterans will still be eligible to receive all current VA health and prescription drug benefits if they choose to enroll in a Medicare prescription drug plan. Veterans do not have to choose between VA coverage and a Medicare prescription drug plan; they may participate in either or both. However, if a veteran decides to enroll in a Medicare prescription drug plan and disenroll from VA, he or she may not be able to re-enroll later if VA is not enrolling all priority groups.
A veteran who is enrolled in both VA and Medicare cannot seek coverage under both programs on the same prescription; the plans are separate and a veteran must choose which plan he or she wants to cover particular prescription. The choice may depend on whether a particular prescription drug is on the list of approved drugs (“the formulary”) for VA or the Medicare prescription drug plan.
If VA takes some action that causes a veteran to lose VA coverage (e.g., VA makes an enrollment decision that would further restrict access to certain Priority Groups), affected veterans can enroll in a Medicare prescription drug plan, without penalty, within 62 days of the end of VA coverage. Enrollment in the Medicare Part D program must be applied for within the 62 day time limit to avoid the penalty.
In addition, 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 Benefits Service Center at 877-222-VETS (8387), or their local VA medical facility.
Individuals with limited income and resources may be eligible for extra help paying for a Medicare prescription drug plan. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov, or call them at 800-772-1213 (TTY 800-325-0778).
This information is about coverage for veterans under the VA medical benefits package. For information on how the Medicare prescription drug program may affect survivors and dependents of veterans eligible for benefits under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), please call 1-800-733-8387 or visit http://www.va.gov/hac/forbeneficiaries/.
For more information on related topics, see the following:
- Information for Veterans Eligible to Enroll in Medicare
- Important Notice from VA about Your Prescription Drug Coverage and Medicare
- Medicare Part D FAQs
- Creditable coverage FAQs
Additional Link Resources:
Federal Benefits for Veterans and Dependents
VA National Income Thresholds |
VA National Geographic Income Thresholds
For questions about Health Care Eligibility, please visit the VA inquiry website.
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