Know a military vet turning 65? Here’s how Medicare can work with VA health care


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Credit: CNBC

If you get health care through the Veterans Health Administration and are nearing your 65th birthday, don’t overlook whether Medicare would make sense for you.

While not all military veterans rely on VA health care, those who do might not realize they can use Medicare alongside their existing benefits.

“Many are in the dark about using both,” said certified financial planner Hans “John” Scheil, CEO and owner of Cardinal Advisors in Durham, North Carolina. “But there are a lot of options for veterans when it comes to Medicare.”

The VA health system provides care for 9 million veterans each year at its 1,250 facilities, including 172 medical centers and more than 1,000 outpatient sites across the country. However, it generally doesn’t cover care outside of those locations.

“With Medicare, you have much broader options,” said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans. “You can have access to doctors and hospitals not near a VA facility, or you might want a second opinion from a doctor outside the system.”

The program encourages those using VA health care to sign up for Medicare when first eligible. Doing so has no impact on your VA coverage.

You get seven months to sign up; the enrollment period starts three months before the month in which you turn 65 and ends three months after your birthday month. For example, if the big day is June 15, your signup window begins March 1 and ends Sept. 30. And remember, signing up for Medicare does not affect your VA health-care benefits.

Medicare Part A, which provides hospital coverage, costs nothing. The standard premium for Part B, which is for outpatient care and medical equipment, is $135.50 for 2019. (Those with higher incomes pay more.)

Like the rest of the population, if you don’t sign up for Part B when you’re first eligible, you could face a life-lasting penalty if you change your mind later. And the longer you delay, the higher the amount that gets tacked on to your premium.

It’s worth noting that for veterans who plan to use TriCare for Life — an insurance program administered by the Department of Defense — you must enroll in Medicare Parts A and B.

Part D, which is for prescription drug coverage, is optional. Some people using VA health care sign up for it so they can get their medicine from non-VA doctors and have their prescriptions filled at their local pharmacy instead of through the VA mail-order service.

However, VA prescription drug coverage generally comes with lower costs than a Part D plan. And, there’s no harm in not signing up: If you don’t do it when you’re first eligible for Medicare and then change your mind later, you won’t pay a penalty because it is considered “creditable” by the Centers for Medicare and Medicaid Services.

Gavino said that some people with VA health care decide to go with a Medicare Advantage Plan, which includes Parts A and B, and typically D. These plans often come with extras such as dental and vision coverage, or gym memberships.

“Some of those plans have a low or no premium,” Gavino said. “If you never want to use the plan, you don’t have to.”

This would mean that it costs nothing unless you use it and face a deductible or copay (or both), depending on the particulars of the plan. You’d also have an out-of-pocket maximum.

Meanwhile, some people with VA health care who sign up for Medicare Parts A and B decide to get a Medigap policy instead of an Advantage Plan (you cannot have both).

This type of supplemental insurance helps cover the cost of deductibles, copays and coinsurance associated with Medicare.

However, you only get six months to purchase a Medigap policy without an insurance company nosing through your health history and deciding whether to insure you. This “guaranteed-issue” period starts when you first sign up for Medicare.

After that window, unless your state allows special exceptions, you have to go through medical underwriting. And depending on your health, that process could cause the Medigap insurer to charge you more or deny coverage altogether.

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