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You can have both Medicare and Veterans Administration VA benefits but, Medicare and the VA benefits do not operate together. Medicare does not compensate for any care that you receive at the VA facility. For your VA coverage to cover your care, you must generally receive health care services at the VA facility. 

Medicare and VA Benefits does not need a coordination of benefits, and it is completely two different systems. 

Your VA benefits coverage may change in the future, or you may even lose it. It is unpredictable to know if enough funding will be approved in a future year to care for all Veterans because VA health benefits depend on an annual appropriation of funds by Congress. 

Do you Need Medicare Part B if you have VA benefits?

It is not necessary, but strongly recommended that any Medicare-eligible Veterans and disabled Veterans enroll in Medicare Part B (medical coverage, doctors’ visits, outpatient services, etc.) There is usually a monthly fee for Medicare Part B, but it is worth it. For 2020 Medicare Part B premiums are $144.60/month.

Important to know, if you do not sign up for Medicare Part B when you become illegible, you may have to pay the late enrollment penalty. Medicare Part B LEP is 10% of the premium for each 12-month period you were eligible but did not enroll. You will have to pay the LEP to the rest of your life if you choose to remain enrolled.  

Do you need any secondary plan in addition to your Medicare when you have Veterans Administration VA Benefits?

Usually, Veterans receive care from VA facilities and do not use their Medicare coverage. In some cases, you may need to see another provider located outside of VA facility or may need to get a drug that is not covered by your VA benefits plan. 

 Let’s look at this scenario:

Joe has VA benefits and gets all services in VA facility. He has both Medicare Part A and Part B. A Few weeks ago, Joe went to see his daughter in another state. He did not have a VA facility close by and was rushed to the hospital Emergency Room.  

In this case, Joe will have to use his Medicare card to get his services in the NON-VA facility. He has to pay Medicare Part B deductible of $198 + 20% coinsurance for his ER visit. Emergency Room visits can cost a fortune in the United States. The Health Care Cost Institute studies show that in 2020, the average ER visit cost is around $3000. 20% out of $3000 is $600. Thanks god, it was nothing serious, and the doctor just prescribed him one of brand name medications that have a retail price of $350. 

Medicare does not cover Prescription Drugs. He had to come up with Prescription Cost out of his pocket. 

If Joe had a Medicare Advantage Prescription Drug Plan, he would have a flat copay for ER visit. Usually, the copay is $90 for the Emergency Room with MAPD Plan. 

Also, with Part C, he would have a copay for a drug, depends on the drug Tier. Brand name drugs can be in Tier 3 (preferred brand drug), Tier 4 (non-preferred brand drug), and Tier 5 (specialty drug). The average cost of medication in T3 – $45, T4 – $100. By looking at these numbers, we can say that it is much cheaper than the retail price of the drug. 

So, how does VA Benefits members can benefit from Medicare Advantage Plans?

Should members with VA Benefits get additional Medicare Plan?

The answer is YES! 

We strongly recommend that people with VA Benefits enroll in low cost or $0/ month Medicare Advantage Prescription Drug Plans!

Being Enrolled in MAPD Medicare Advantage Prescription Drug Plan (Part C) does not interfere with your Veteran Administration coverage. We help people like this in NY all the time. We have lucky in 5 boroughs and Long Island to have such a big selection of MAPD plans. Lots of our clients live in Brooklyn, have VA benefits, and use the Brooklyn VA Medicare Center. They also enroll in MAPD plans. That way, they don’t have a fear of maximum out of pocket with Original Medicare, coverage for the drugs in case of emergency, etc. 

By having an MAPD plan, you can get extra benefits like Gym Membership through Silver Sneakers or MyRenewActive. Through this membership, you can access gym facilities like NY Sports Club, YMCA/YWHA, Blink, Shore Front, Curves, Lucille Roberts, LA Fitness, and many more for FREE.

Some Medicare Advantage plans have Dental, Vision, and Hearing benefits. 

The most important, that all Medicare Advantage Plans have Maximum Out of Pocket limit. 

Medicare Advantage plans must limit how much their members pay out-of-pocket for covered Medicare expenses. The maximum out-of-pocket limit is $6,700 for in-network services and $10,000 for out-of-network services. … After reaching the limit, Medicare Advantage plans pay 100% of eligible expenses.

In New York, we even have plans that offer OTC cards in MAPD plans. Over the Counter, a card is a debit card that you can use in the local network store to buy essentials like vitamins, non-prescription drugs, and much more. Some of the participating locations are Family Dollar, Walmart, Dollar General, Rite Aid, CVS, etc. Lots of small neighborhood pharmacies are also in OTC Network.  

By having Part C that has Drug coverage, you will be able to get your prescription from a non-VA doctor filled in the local pharmacy, and you will be able to see a local specialist for a flat copay. You will have access to more providers in your plan network. 

We work with top private insurance companies that offer MAPD plans in New York and New Jersey areas. 

If you have VA benefits and live in Brooklyn, we will be glad to meet with you one on one and answer questions you may have about Medicare Plans. Our office conveniently located in the Sheepshead Bay area next to public transportation.

If you are in NY or NJ and do not travel, we can conduct an appointment over the phone or online via the ZOOM web meeting.