Medicare Advantage for Veterans in Texas
It may seem that Medicare Advantage for veterans is not necessary for retirees using TRICARE or VA health coverage, but it could be beneficial more than you know.
One thing to note, there are Medicare Plans that will work with Tricare or VA health coverage.
I’ll go over how they can work together to make sure you have effective and convenient healthcare coverage.
Medicare Advantage and VA combination in Texas
First, to get into a Medicare Advantage (MA) plan, you have to have both Medicare Parts A and B. That’s something the VA recommends you to do anyway.
Medicare Advantage for Veterans provide the same coverages with extra added benefits that Original Medicare doesn’t. But here’s how the combination of Medicare Advantage and VA can benefit:
- MA plans cover all your needs in one convenient plan
- Sometimes there are lengthy wait times associated with a VA facility so opting to go to a different clinic may be beneficial to you
- Eligibility for VA health coverage is not always guaranteed and can be subject to change
- Adding an MA plan increases your healthcare flexibility and benefits
- Medicare Advantage plans puts an out-of-pocket maximum on your healthcare. That is something Original Medicare does not do
- It will also cover you if you’re on a vacation outside of the United States
- There are MA plans that have “buy back or give back” programs that can help you pay for your Medicare Part B premium. This puts more money in your pocket on a monthly basis.
Medicare Advantage Benefits for Veterans in Texas
Medicare advantage plans are required by Medicare to provide the same coverage as they do as Original Medicare. This includes inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care, outpatient care, medical equipment, and some preventative services.
However, Advantage plans can also provide additional benefits like:
- Adult day-care services
- Dental coverage
- Free Fitness memberships
- Hearing aids
- Nutrition programs
- Over-the-counter medications and items
- Services and supports for those with chronic conditions
- Transportation to doctor visits
- Vision
- Wellness programs
These benefits you are eligible, but will depend on your area and plan providers.
When to enroll into a Medicare Advantage
Once you are eligible for Medicare, you can get into a Advantage plan. Although, there are specific times in which you can enroll:
Initial coverage election period (ICEP) — The initial coverage election period is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and have been receiving Social Security disability income (SSDI), you qualify for Medicare on the 25th month after you begin receiving your Social Security benefits. If you become eligible for Medicare that way, you can enroll into an Advantage plan three months before your month of eligibility up to three months after you became eligible.
Annual election period (AEP) — Also known as open enrollment or AEP, the famous Annual Election Period for Medicare Advantage is October 15 and continues through December 7 every year. Coverage for the Part C plan you choose during this time will begin January 1st the following year. During this time you can also add, change, or drop current coverages.
Medicare Advantage Open Enrollment Period (OEP) — this open enrollment period gives you the ability to change from one Medicare Advantage plan to another or drop an Advantage Plan to return to Original Medicare.
Special Election Period (SEP) — There are certain circumstances that can qualify an individual to enroll into a Medicare Advantage program. It is best to speak to a licensed Medicare insurance agent to find out if you qualify for a special election period or not. However, there are a some common instances that occurs often:
New to Medicare
Moving In or Out of service areaOut of service area
New to Medicaid
Loss of Medicaid
New to Low Income Subsidy (L.I.S.)
Loss or L.I.S.Leaving Employer’s Health Plan
If you have a chronic disease like Diabetes or Heart Failure
These are the most common Special Election Periods one can have in order to get into or switch Medicare Advantage Plans.
What are types of Veteran Healthcare?
Tricare for Life is for retired military veterans who served more than 20 years and for their dependents and for surviving spouses of soldiers killed in action.
ChampVA is a VA benefit for dependents of living veterans rated 100%. They are also for dependents of veterans who died service connected and for dependents of veterans who were 100% rated when they died.
VA Healthcare system. Only Veterans can enroll in the VA health care system. Dependents and the family members do not receive credible coverage under the Veteran’s enrollment.
How does Tricare for Life/ChampVA work with a Prescription Drug Program (Part D)?
Both Tricare For Life (TFL) and ChampVA offers a pharmacy program that provides creditable drug coverage for their members. This means that if you are enrolled in the TFL or ChampVa pharmacy program, you can delay or not take part in the Part D enrollment without incurring any late enrollment penalties (LEP).
I am a veteran, but I do not have neither Tricare for Life or ChampVA…Do I need get Medicare Part D?
This is a complicated answer. The short answer is no! Enrollment in a VA healthcare system is considered creditable drug coverage for Part D purposes. The problem and my main concern is that I have heard that the VA does not like to give brand name medications to their members. This is a case by case basis and you should discuss with your doctor which route is best for you.
Medicare drug plan is always your choice. You are not required to join a Medicare drug plan; it is always optional.
What types of Medicare Advantage Plans will work with me?
Whether you have Tricare, ChampVA, or enrolled in the VA healthcare system…the only Medicare plans that are good for you to enroll in are Medicare Advantage only plans (MA) without the Prescription Drug coverage. There are two types of Medicare Plans. Medicare Advantage with Prescription Drug coverage (MAPD) and Medicare Advantage Plans (MA). Usually civilians will enroll in an MAPD plans while veterans will enroll in a MA only plan.
Add Medicare Advantage to your Coverage
How does Tricare For Life or ChampVA coordinate with Medicare Advantage Plans in Texas?
If you have CHAMPVA or Tricare for Life and you join a Medicare prescription drug plan, Medicare will be the primary payer and CHAMPVA/TFL will be the secondary payer. This means that Medicare will pay first and CHAMPVA/TFL will reimburse your co-payment. You will be responsible for any costs not covered by these programs.
Why do I need to enroll in an MA only plan?
The reason why you need can enroll only in a Medicare Advantage only plan is because you already have drug coverage. So any veteran drug program you are enrolled in will coordinate with a Medicare Advantage only plan of your choice.
Can I lose my CHAMPVA/TRICARE?
No. This is a common misconception. You can never lose these benefits. If you are a Tricare member and are enrolled in an MAPD plan…your Tricare drug coverage will not coordinate. That is all. So to fix this is to pick a plan that is MA only.
What is the main benefit in getting into a Medicare Advantage Plan without prescription drug coverage?
There are a lot of Medicare Advantage Plans that have a “Buyback or Give back.” What this means is that if you are enrolled in these plans…that insurance company will give you a certain amount of money back. It can range anywhere from $50.00 to your full premium on a monthly basis. You should discuss with a Medicare agent to see what are your best options. Pick me!
Which Medicare Advantage Plan in Texas is best for me?
Every year Medicare Advantage plans change. Sometimes they get better, sometimes they get worse. The best way to determine what to do is to call me so I we can discuss your options and your healthcare needs.