Are Military Health Benefits Enough?

Are Military Health Benefits Enough?

Loren Bailey

by Loren Bailey

Senior Wealth Manager

If you watch TV or read the news, you are probably aware of the fact that we are in the midst of the Annual Enrollment Period (AEP) for Medicare. With the numerous commercials invading our living rooms, the message is clear – “Sign Up!” Many people are already comfortable with their post-retirement healthcare situation and those who spent time in the armed forces may think that their current Veterans Administration (VA) or Tricare For Life (TFL) coverage is adequate. However, limiting your coverage to only the military-sponsored programs may cost you in terms of time, energy and, most importantly, coverage! Combining VA or TFL benefits with Medicare may enable you to greater healthcare options and allow you to enjoy a better retirement lifestyle. 

How so? Let’s quickly review the situation. For the purposes of military healthcare post-retirement, there are 2 classes of ex-military personnel:

  1. Veterans – those who have served and left service with an honorable discharge, and
  2. Military Retirees – those who have retired from the Armed Forces after a 20+ year career. 

For Veterans who served and have gone on to establish careers outside of the military, they are eligible for healthcare and prescriptive drug benefits through VA programs. However, their coverage may be limited as the veteran’s rating with the VA may have an impact on the level of benefits received. Another consideration is that it can take 9 to 12 months to get registered in the system and start receiving care. Also, veterans could be denied or limited services with the VA because of their income level. 

Military Retirees qualify for TFL if they are eligible for Medicare Part A and enrolled in Medicare Part B. For retirees, the TFL plans are available in addition to VA plans. While VA plans offer basic coverage, the TFL plans are more in-depth. Medicare and TFL work together to help minimize your out-of-pocket expenses. They are akin to a Medicare Supplement Plan with drug coverage, however, there are times and situations where costs may not be covered by either Medicare or TFL. A couple of examples are shown on a chart below:

Military Health Benefits

The good news is that even though military health coverage is available, both Veterans and Retirees can enroll in Medicare Advantage Plans! At this point, you might still be asking “If I am already receiving ‘reasonable coverage,’ why get a Medicare Advantage plan? What’s the point?” The answer is that combining VA plans with Medicare Advantage – Prescription Drug Plans (MA-PD) or TFL Plans with Medicare Plans (MA) may give both veterans and retirees greater access to health care. It can allow for greater coverage, as well as more programs and benefits, without the risk of impacting any existing VA, TFL, or other military benefits. Below are some answers to common questions regarding Medicare Advantage:

 

  • Why would a veteran with VA benefits enroll in a Medicare Advantage Plan? A Medicare Advantage Plan that includes a drug plan would allow the consumer to still receive VA benefits through the VA network (including the VA pharmacy) but also give additional options within the MA-PD plan’s network for additional doctors and pharmacy benefits. Access to care can be greatly increased. 
  • What is the value of enrolling in Medicare Part A and B while having VA health care? There are more choices for physicians and drug prescriptions, more opportunities for second opinions, a greater possibility of seeing a physician sooner, and access to benefits outside of the VA facilities’ area. 
  • Can a Medicare-eligible person have a VA, TFL, and a Medicare Plan? Yes. Veterans can have a combination of all three coverages without jeopardizing status in any of the other plans. Remember, VA benefits are earned and isolated benefits. They are not contingent upon other coverage, and it is a stand-alone benefit. TFL benefits are those that can be used in conjunction with Original Medicare (Medicare Parts A and B) or an MA plan. They can also be used in conjunction with a VA plan.
  • Would a person with TFL want a Medicare Advantage Drug Plan? In most cases they would not. Since TFL’s drug plan coverage is quite extensive, an MA-PD plan is usually not needed. MA without a drug plan is usually better. However, there may be a few reasons why it could make sense. For example, it would be preferred if a drug needed is not on the TFL drug formulary, or if a member would rather get prescriptions filled at a major retail location instead of using the TFL mail order requirement. 
  • Can TFL pay for MA plan copays on the veteran’s behalf? Yes. If the VA/TFL member has an MA plan, they can advise the medical provider and have the MA plan directly pay for the copays. Or, they can have the copays reimbursed after sending in a claim for reimbursement to TFL. In some cases, the provider may submit claims to Tricare for the member but the veteran should check with each provider to confirm their billing process.

These are but a few questions that are asked about using MA plan along with veteran plans. To ultimately answer if a Medicare Advantage addition would help you, there are a few questions that you can ask yourself: 

 

 

  • What is your disability rating with the VA? 
  • Have you been means tested by the VA? 
  • Do you have TFL coverage and, if so, do you use services at a VA healthcare center? 
  • Would it make sense to have a back-up healthcare plan? 

 

Also, it is always advised to enroll in Medicare Part B when eligible, even if you do not plan to benefit from it at that moment. The Social Security Administration wants to ensure that consumers pay premiums into policies for which they plan to benefit, so getting Part B later could incur a late penalty. What happens if you have not enrolled in Part B yet but are interested in an MA plan? The good news is that it may be possible to waive the late penalty. As part of the Affordable Care Act (ACA) of 2010, those who are Medicare eligible can make an in-person appointment with their local Social Security office and appeal for a waiver for the late enrollment. While there are no guarantees, it is certainly worth trying and applying. 

 

Keep in mind that another potential benefit of enrolling in a Medicare Advantage Plan is that you can work with a dedicated, licensed Medicare Agent to help you navigate through the plan and the process. But ultimately, whether a Medicare Supplement Plan would be beneficial for you depends entirely on your individual situation. 

 

If you still have questions on whether you should pursue this path, we can help! Because we partner with United Healthcare, we can aid in answering your questions. We can clarify the intricacies of Medicare and the Medicare Advantage Plan options. We can guide you through the maze of information and assist with the choices. Contact me on our website or call us at 1-800-310-2828. We can help you find your right solution!