Medicare-eligible veterans with only VA coverage are subject to a late enrollment penalty for Part B. That's because enrollment in the VA health care system is not considered creditable coverage.
Full Answer
Why can’t I get Medicare Part B through the VA?
That's because enrollment in the VA health care system is not considered creditable coverage. Creditable coverage for Medicare Part B (meaning health insurance that can take the place of Part B) can only be provided by certain employer group health plans.
Is there a late enrollment penalty for Medicare Part B?
Medicare-eligible veterans with only VA coverage are subject to a late enrollment penalty for Part B. That's because enrollment in the VA health care system is not considered creditable coverage.
Does VA health care count as creditable coverage?
Since only Veterans can enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment. Under Medicare Part B, VA health care is NOT creditable coverage. Creditable coverage under Medicare Part B can only be provided through an employer.
Are VA benefits creditable under Medicare Part D?
VA benefits are only creditable coverage under Part D. VA benefits are NOT creditable under Part A and Part B. This is something that is HIGHLY miscommunicated to veterans. Even if you have medical coverage under the VA, there are still many reasons to enroll in Medicare coverage to work with your VA benefits.
Does VA coverage count as creditable coverage for Part B?
Under Medicare Part B, VA health care is NOT creditable coverage. Creditable coverage under Medicare Part B can only be provided through an employer.
Do I need Medicare Part B if I have VA coverage?
Therefore, it is beneficial to enroll in the hospital insurance you earned through Medicare. However, like other beneficiaries, veterans with VA benefits will need to pay a standard Medicare Part B premium for Medicare's outpatient coverage. You will want to enroll in Medicare Part B as soon as you are eligible.
Can the VA be secondary to Medicare?
You can have both Medicare and Veterans Affairs (VA) benefits, but Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility.
Does VA follow Medicare guidelines?
If you have other forms of health care coverage (like a private insurance plan, Medicare, Medicaid, or TRICARE), you can use VA health care benefits along with these plans.
Is VA insurance primary over Medicare?
The VA pays for VA-authorized services or items . For active-duty military enrolled in Medicare, TRICARE pays first for Medicare- covered services or items, and Medicare pays second . For inactive-duty military enrolled in Medicare, Medicare pays first and TRICARE may pay second .
Is VA insurance always primary?
VA health benefits always provide primary coverage in VA facilities. If you have VA benefits and become eligible for Medicare, you should consider the benefits of both types of insurance and whether you should enroll in Medicare now or delay enrollment—and the potential consequences of delayed enrollment.
Do veterans get free healthcare for life?
You can get free VA health care for any illness or injury that we determine is related to your military service (called “service connected”). We also provide certain other services for free.
Can you have a Medicare Advantage plan and VA benefits?
You can have both. Coverage through a Medicare Advantage Plan does not conflict with VA health care services and would increase your flexibility and options in terms of how and where you receive health care.
Are VA benefits better than Medicare?
VA coverage for prescriptions is typically less expensive than Medicare Part D drug plans, and you won't be hit with late penalties if you lose VA coverage in the future, provided that you sign up with a Part D plan within two months of that coverage ending.
What is the best Medicare plan for military retirees?
Military retirees with TRICARE For Life coverage may consider the AARP Medicare Advantage Patriot Plan. This plan provides the freedom to visit doctors and hospitals in our network for a $0 monthly premium and additional benefits that may include: Monthly credits applied to your Medicare Part B premium.
Do military retirees pay for Medicare Part B?
Military health coverage entitles the service person to delay Medicare Part B enrollment until a future date. They will be eligible for a Special Enrollment Period (SEP) to enroll in Medicare Part B without penalty when they leave active duty medical coverage.
What is the difference between military healthcare and the VA?
The VA is not the same as the Military Health System or TRICARE. The VA's system is separate from the health-care system that the military uses for active-duty personnel, retirees, dependents, and military families. The military, instead, operates the Military Health System.
How long does Medicare have to be in effect to be late?
The MMA imposes a late enrollment penalty on individuals who do not maintain creditable coverage for a period of 63 days or longer following their initial enrollment period for the Medicare prescription drug benefit.
What is creditable coverage?
The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug ...
How long does it take to complete a CMS 2nd disclosure?
The Disclosure should be completed annually no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination ...
What happens if you enroll in Medicare and keep your insurance?
If you enroll in Medicare, have creditable coverage, and keep your insurance, your current provider would be your primary insurer. Medicare would be your secondary insurer. You may decide to let your current insurance lapse.
When do you need to show coverage to Medicare?
You’ll need to show it to Medicare when you enroll to avoid having to pay late enrollment penalties. If your current insurance is not creditable, you’ll receive a noncreditable coverage disclosure notice. These notices typically mail out each September.
What happens if you lose your Medicare?
If you lose your current coverage, this triggers a special enrollment period during which you can sign up for Medicare without penalty. If you don’t have creditable insurance coverage and delay signing up for Medicare, late fees and penalties may apply.
How long do you have to enroll in Medicare if you lose your current coverage?
If you lose your current coverage, you should enroll in Medicare within 8 months. This is known as a special enrollment period.
What is creditable coverage?
The takeaway. Creditable coverage refers to health insurance that covers at least as much as — or more than — Medicare. If you have creditable coverage, you may choose to keep it instead of or in addition to Medicare.
How much is the late enrollment fee for Medicare Part B?
For Part B, you’ll be required to pay a late enrollment fee of an extra 10 percent of your monthly premium amount for each 12-month period you didn’t sign up. This penalty lasts for as long as you have Medicare Part B coverage.
How long do you have to sign up for Medicare if you lose your credit?
If you lose your creditable coverage, you must sign up for Medicare within 8 months; otherwise, penalties and late fees may apply. If you’re eligible for Medicare but already have health insurance, you may be wondering whether you should keep it or switch.
Is VA coverage good for Medicare?
Enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes. This means VA prescription drug coverage is at least as good as the Medicare Part D coverage. Since only Veterans can enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment.
Can veterans use private health insurance?
Veterans with private health insurance may choose to use these sources of coverage as a supplement to their VA health care benefits. Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance.
Do veterans have to provide information on their health insurance?
All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA copay responsibility.
Can veterans get prescription drugs from community physicians?
For example, Veterans enrolled in both programs would have access to community physicians (under Medicare Part A or Part B) and can obtain prescription drugs not on the VA formulary if prescribed by community physicians and filled at their local retail pharmacies (under Medicare Part D).
What Does Creditable Coverage Mean?
Creditable Coverage is essentially medical and drug coverage by other means than Medicare that is ‘equal to or better than’ Medicare coverage. When an individual becomes eligible for Medicare, many times they have a choice between Medicare coverage and other types of coverage they are eligible for or already using.
Employer Coverage – The Package Deal
This is the most common health coverage we encounter with a new client looking to evaluate whether or not the coverage is considered Creditable and whether or not they should leave the employer plan and pick up their Medicare coverage. Early on, the rule of thumb agents hear about is regarding the size of the employer.
How Will I Know What To Do?
To avoid any lifetime penalties, it is important to know when you turn 65 whether or not your current coverage is Creditable so you can decide if you should continue on it or enroll in Medicare. Do not assume what you have is good and not consider Medicare at 65.
What Does Medicare Consider Creditable Health Insurance Coverage?
Medicare states that any health plan offering benefits equal to or greater than its own is creditable coverage. So if you have this level of coverage, you won't get penalized for delaying Medicare enrollment.
What's the Difference Between Creditable and Non-Creditable Coverage?
Unlike creditable coverage, non-creditable coverage has fewer benefits than Medicare.
Is a Medicare Advantage Plan Considered Creditable Coverage?
Medicare Advantage (Medicare Part C) plans are a private insurance alternative to the federal government's Original Medicare program (Medicare Part A and Part B). Part C plans bundle hospital and outpatient coverage and usually include prescription drug coverage.
How Do You Calculate Creditable Coverage?
There are penalties for late enrollment in Medicare Parts B and D, so it's essential to ensure you have creditable coverage for outpatient services and prescription drugs.
How Do You Prove Creditable Drug Coverage?
If you have creditable drug coverage, your plan provider will send you a Notice of Creditable Coverage .
Do I Need a Certificate of Creditable Coverage?
A certificate of creditable coverage is a document that insurance companies can issue to indicate that someone has terminated their coverage. It shows the insured person's name, the period they held insurance, and when they canceled their policy.
Deciding to Enroll in Medicare
Before deciding whether to enroll in Medicare or continue your existing health plan, make sure you know whether you have creditable coverage.
Do veterans have to enroll in Medicare?
Bottom line: Veterans who believe that there’s a chance they will need Medicare services or perhaps receive care at a Medicare hospital sometime down the road should enroll when first eligible. If they don't, they will face a late enrollment penalty.
Is Medicare Part B late enrollment?
Medicare-eligible veterans with only VA coverage are subject to a late enrollment penalty for Part B. That's because enrollment in the VA health care system is not considered creditable coverage. Creditable coverage for Medicare Part B (meaning health insurance that can take the place of Part B) can only be provided by certain employer group health ...