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VA & Tricare

TRICARE

Thank you for your career service!  In short, you have earned your Tricare For Life benefits so there is nothing to add.

A quick way to severely impact your Tricare benefits and create financial havoc is to enroll in a plan with Part D coverage.  In fact, do not speak to an insurance agent about Tricare.  Even me.  Contact your Tricare administrator.

VA

I have VA benefits, so I don’t need Medicare or Part D right?

First of all, thank you for your service to this country.

Some veterans are under the impression that VA benefits are insurance.  Not so, and the VA states it at their website and in their handbook.

If you have a service connected disability as determined by the VA (not Social Security, that’s different criteria) of under 50%, the VA will not pay for medical services outside of the VA system without prior approval and on a case by case basis. There are some exceptions granted, but you cannot count on it!

For example, let’s say you have a heart attack and call an ambulance.  If you are able, you request the ambulance crew to transport you to the VA hospital (and that may or not be close).  The ambulance crew has a legal and ethical obligation to transport you to the nearest emergency care center and that is not the VA.  Assuming you are admitted to a non-VA hospital wishing further treatment at the VA, it is possible you may be transferred to the VA upon request.  However you will be responsible for the first ambulance transport and non-VA hospital charges.

Another risk.  If you delay Medicare Part B when eligible because you think the VA is taking care of  your medical needs outside of the VA system, you will encounter a penalty added to your monthly Part B premium.  Wait long enough, Part B will become unaffordable.  Medicare’s calculator will help you determine what applies to you.

As for needing Part D coverage, the VA may be sufficient for your needs and safely opt out.  Keep in mind that the VA only dispenses generic medications.  Brands may be dispensed only on a case by case basis.

Contact Me for knowledgeable advice.  An Advantage plan might offer lesser expensive medication co-pays than the VA!

2 thoughts on “VA & Tricare”

  1. I have a 100% VA disability. I live in Weiser Idaho.

    I would like to have a local doctor available as I am a by-pass heart patient and an insulin dependent diabetic. I understand that the VA will not fill prescription from outside doctors. Is that correct?

    It is about a 150 mile round trip for me to go to Boise to the VA. If I don’t have an appointment I have
    to go to the VA ER. The VA has taken very good care of me and I am grateful. I will continue to go there but in an emergency I think I should also have a local doctor that is familiar with my health status.

    Should I also have a Medicare Part D plan? I do have a very good supplement insurance but they do not offer Medicare Part D coverage.

    Thank You
    Hal

    1. Thanks for writing Hal! Very good questions and thank you for your service to this country.

      As you noted, the VA does a good job taking care of our veterans, however the VA system does have rules not unlike HMOs that are a growing healthcare segment in Idaho. VA health care is a closed system whereby delivery is not provided outside of it in most cases. Your questions indicate you have a very good understanding of how the VA system works and I think there is good news for you.

      Since your have a 100% military disability rating, the VA has more latitude to approve treatments outside of the system. Approval is the key word here. There are many veterans unlike you that have a low or no disability rating that think the VA is insurance and it is not. It is a benefit which is subject to the changing winds of funding and policy. Hence, any care delivered outside the VA requires pre-approvals (even emergencies) and are handled on a truly case-by-case basis. I add this as many (not you) do not have this understanding.

      The medications prescribed to you at the VA are a benefit that can only be accessed within the VA and that is true. A work around is to have your VA physician write prescriptions on their own private script so you can get them filled closer to you. Be aware however, you are then subject to prescription cost. Likely you are receiving a no co-pay benefit when prescriptions are filled at the VA. That will not be the case outside the VA.

      You are correct that Medicare supplement plans do not include drug coverage. You can obtain a separate Part D plan to gain coverage outside of the VA. Like your supplement, the VA will not pay the monthly premiums or subsidize the co-pays of a drug plan. A Part D plan will however meet your need to fill prescriptions more conveniently. Considering your transportation costs, this alone may be a money saver for you.

      Since you have a Medicare supplement that covers all or part of the costs that Medicare leaves behind, you already have access to nearby physicians. You’ll need to check your plan’s coverage to know if you are subject to any Medicare co-pays. All providers that accept Medicare, must accept your supplement.

      For other readers with Medicare Advantage plans, keep in mind you DO NOT have a supplement like Hal. Plan acceptance by a provider can be very different.

      I can help you explore Part D plans. It would be best to give me a call at 208.484.0608 to work with you.

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