By Dr. Katy Votava, PhD, RN
RETIREMENT DAILY GUEST CONTRIBUTOR, NOV. 11, 2022, 7 am EST
Maximizing Medicare and Military health benefits can significantly aid actives and Veterans to avoid out-of-pocket expenses. Find out what you're eligible to receive below.
Whether active duty or Veteran, there are important intersection points between Medicare and military health coverage. Those points fall into three categories:
- TRICARE is a federal health insurance program for active duty, retired military personnel, and their family members who are not Medicare eligible.
- TRICARE for Life for Medicare-eligible retired military and their spouses. It is a comprehensive supplement to Medicare and provides prescription drug coverage.
- Veteran Administration (VA) health benefits for those who have served in the military
There are different TRICARE programs:
While on active duty, most service personnel have a variety of military healthcare options. As is the case in the civilian world, if a service person becomes Medicare eligible, they need to consider their Medicare options, particularly as they relate to Medicare Part B. Active-duty health coverage entitles the service person or their spouse to delay Medicare Part B enrollment until a future date. They will be eligible for a Special Enrollment Period (SEP) to enroll in Medicare without penalty when they leave active-duty medical coverage in the future.
However, suppose you are Medicare-eligible and an active-duty service member or spouse of an active-duty service member. In that case, you must enroll in Parts A and B to avoid a lapse in coverage when you retire. Like any other person with employer coverage and is Medicare-eligible when they retire, you have a Special Enrollment Period. You can enroll in Medicare at any time during the year.
Retired military who are under 65 years of age and their spouse can enroll in TRICARE for cost-effective, comprehensive health coverage. When a military retiree or spouse reaches 65, they are eligible for Medicare and TRICARE for Life medical coverage. TRICARE for Life is specifically for Medicare-eligible military retirees.
Medicare pays first for Medicare-covered services. TRICARE for Life will pay the Medicare deductible, and coinsurance amounts and any service TRICARE for Life covers that Medicare does not cover. The retiree and spouse can also enroll in TRICARE dental plan options.
TRICARE for Life beneficiaries must enroll in Medicare Parts A and B. They do not need to enroll in Medicare Part D because TRICARE for Life includes Medicare Part D creditable coverage. If they join a Medicare Part D plan, that plan pays first, and TRICARE for Life pays second. A Medigap plan or Medicare Advantage is unnecessary, given that TRICARE for Life functions as a Medicare supplement. That said, a person can opt into a Medicare Advantage plan, and TRICARE for Life will coordinate benefits.
In my experience, people seldom benefit from joining either a Medicare Advantage plan or Medicare Part D plan in addition to TRICARE for Life. A bonus of TRICARE for Life is that it includes coverage of international health care services, including for those who live abroad for extended periods as ex-pats.
Veteran’s Administration (VA) health coverage is for U.S. military veterans. These benefits are available to most veterans, whether retired military or not. Current and former members of the Reserves or National Guard who are called to active duty by a federal order and completed the entire period for which they served may also be eligible for VA health benefits.
The VA offers a wide range of health benefits based on the Veteran’s needs, circumstances, and specific requirements. VA health benefits can include the following:
- Inpatient and outpatient care at VA medical facilities
- Prescription medications from VA providers
- Long-term care depending on needs, income, and space availability
- Care from community health care providers when the VA cannot supply the care
- Mental health care
Veterans who meet a hierarchy of enrollment criteria may receive a significant part of their health services through the VA. If that person needs care outside of the VA system, they will need to pay for that or have other coverage. Veterans who are not retired military often need a Medicare Advantage with a Part D plan or a standalone Medicare Part D plan as backup coverage.
VA prescription drug coverage can pay for a significant part of a person’s prescriptions at a low cost. This is a valuable benefit that is available to most Medicare-eligible veterans. It is worth considering because cost savings can be significant. Given that the VA does not cover all medications, I recommend that the person join a Medicare Part D plan or Medicare Advantage Plan as a backup. They cannot use both types of coverage for the same prescription simultaneously.
Where to Find Help
If you are:
A veteran or have served in the U.S. military, contact the Department of Veterans Affairs to get answers to your questions about VA benefits: Call 1-800-827-1000, TTY 1-800-829-4833, or visit www.VA.gov
Retired military whether Medicare eligible or not, can contact TRICARE to decide which regional office covers them and find associated information: Call 866-773-0404 or visit www.Tricare.mil