Veterans who utilize benefits from TRICARE or the Veterans Affairs can still obtain Medicare coverage. Having secondary insurance could prove very useful and save members a lot of money.
Let’s talk about how the two plans work together.
Medicare Advantage and VA combination
If you choose to enroll in a Medicare Advantage Plan, TRICARE becomes your supplemental insurance policy. Your Medicare Advantage Plan will be the primary payer and send any amount not paid to TRICARE for processing and payment.
TRICARE will typically cover the deductibles, copays, and coinsurance not covered by your Advantage plan. It is even possible to have no out-of-pocket costs.
If your Advantage plan does not cover a particular service, but TRICARE does, you will be responsible for any expense not paid for by TRICARE.
Another benefit to obtaining an MA plan is that while sometimes there are wait times or travel associated with care from a VA facility, you will not have this with an MA plan. Lastly, eligibility for VA healthcare is not guaranteed. It could change at any time.
Medicare Advantage Benefits
Because Medicare Advantage plans bundle benefits from Medicare Parts A and B, they must offer the same benefits provided by Parts A and B. This coverage applies to inpatient and outpatient care, skilled nursing facility care, diagnostic tests, surgeries, home health care, durable medical equipment (DME), and preventive services.
Medicare Advantage plans include additional benefits not seen in Original Medicare. Some of these services are:
- dental care
- hearing exams
- hearing aids
- vision exams
- glasses or contact lenses
- gym memberships
- wellness and nutrition programs
- over-the-counter drugs
- prescription drugs
- adult daycare
- transportation to doctor visits
- services for chronic conditions
When to enroll
Once you are enrolled in both Medicare Parts A and B, you can also enroll in a Medicare Advantage plan. There are specific enrollment periods that apply to Medicare Advantage plans.
Initial Election Period
Each individual has their Initial Election Period. This period begins three months prior to your 65th birthday and extends three months after your 65th birthday, for a total period of seven months.
If you are receiving disability benefits from Social Security, you are eligible for Medicare after receiving disability benefits for 24 months. You may apply for an MA plan three months prior to your eligibility date (which would begin on the 25th month of your disability benefits). This enrollment period extends to three months after your eligibility date.
Special Election Period
To qualify for a Special Election Period, you must meet specific requirements. The most common way individuals qualify is if they postpone enrollment into Original Medicare because they have other creditable insurance coverage. Once the individual enrolls in Original Medicare, they are also eligible to enroll in Medicare Advantage.
Other qualifying events include moving outside your plan’s coverage area, your plan getting terminated for reasons outside of your control, or you qualify for Extra Help.
To find out if you qualify for a Special Election Period, give Senior Benefit Solutions a call!
Annual Election Period
The Annual Election Period (AEP) occurs each fall from October 15 through December 7. During this time, you can choose to change or drop your current Part C plan. Your new coverage will begin on January 1.
Medicare Advantage Open Enrollment Period
This is often confused with AEP. However, there are other things you can do during the Open Enrollment Period, which runs from January 1 through March 31 each year.
During Open Enrollment, you may disenroll in your current MA plan and switch back to Original Medicare. The opposite is also true – you may change from Original Medicare to Medicare Advantage.
You may also switch MA plans, disenroll from your Part D prescription drug plan, and switch from your current Part D plan to another Part D plan.