Joanne: If you or a loved one served in the United States Armed Forces, you may be eligible for insurance and coverage options thanks to that service. We're going to highlight what you should know about unique Medicare options for veterans in today's episode. 

Cameron: But before we start, my name is Cameron Giardini, and together with my co-host, Joanne Giardini Russell, we operate Giardini Medicare, which is an independent insurance agency based out of southeast Michigan.

Although we are based in Michigan, we work virtually over the phone to directly help consumers in about 13 states find the right Medicare coverage for them. If we do not work in your state, we will still connect you with another trusted independent agent that will be able to help you find the coverage that you want.

And we also want to announce that we now have a free online course available for you to register for. And you can do this by going to gmedcourse.com, which is gmedcourse.com. So with that out of the way, a brief overview of today's episode, we are going to cover the veteran's health benefits that are actually through the VA.

We'll talk about eligibility coverage and how they work with Medicare. We'll discuss Medicare supplements and Medicare Advantage plans and how they may or may not coordinate with this VA health coverage. We will also talk about TRICARE for life eligibility, the coverage for that, and how it works with Medicare.

We will also talk about TRICARE for life. Again, with Medicare Advantage or Medicare Supplement coverage, how may or may not work together? And then lastly, we will finish by talking about CHAMPVA eligibility, the coverage with CHAMPVA, and also how that works with Medicare. And then, of course, we will round it out by talking about Medicare Advantage or Medicare Supplement coverage and what you need to know about those when it comes to CHAMPVA.

So first, Joanne will kick it off and talk about the actual VA itself and VA health benefits. Yeah, 

Joanne: there are a lot of parts here. No wonder it's just listening to you. It sounds confusing. So let's get right into what VA coverage is. So VA health benefits are provided by the United States Department of Veteran Affairs, which we're going to refer to as VA, and this constitutes a comprehensive medical package for enrolled veterans.

According to VA.gov, the comprehensive VA benefits include a wide variety of inpatient and outpatient services. The VA provides preventive services like immunizations and screening tests, outpatient diagnostic services like primary and specialist care, surgery, mental health, and prescriptions. The VA also provides inpatient hospital service at the VA facilities.

Some veterans may be eligible for additional services like long-term care or dental coverage. Now, we're going to link to the va.gov link in the show notes and the Veterans Health Benefits Handbook. That'll be in the show notes, and this is specifically going to talk about the services that are provided by the VA health system.

So, let's talk for a second, too, about who is eligible for VA health benefits. There are a few different factors that go into VA coverage eligibility, and this can include their record of military service, their active duty obligations, disability status, financial circumstances, and even some additional possible criteria.

But for the sake of this episode, we're not going to get into the actual specifics there. The best term that we have heard in regards to determining VA eligibility is when in doubt, Fill it out, meaning apply for the VA health benefits. Even if you think you may or may not qualify. It's worth filling it out to see if you are gonna qualify.

You can apply for VA benefits by calling the VA directly for more information, or you can go online to www.ebenefits.va.gov. There are also organizations like the VFW, the service officers there can actually help you with eligibility and application 

Cameron: processes. Yeah, so really good and really important overview there again, just talking about eligibility a lot of times people aren't aware that they are eligible for the VA or sometimes people think they're eligible when they're not, it's not for every single person that serves, you know, for example, I was in the National Guard.

I didn't do a whole lot. So I don't have access to the VA, you know, didn't go overseas, don't have any disabilities related to it. So it depends on your specific service, but As Joanne said, it never hurts to ask. There are a lot of details here, and there's way too much that we can get into as far as exactly what the VA covers, but we do want to cover some of the important concepts and those are the VA priority levels, as well as the copays that people might pay at the VA.

 When it comes to VA priority levels, unlike what it sounds like, the VA priority level, doesn't really impact how quickly you're going to be seen at a facility once you need services. So if you have an emergency or if you, you know, if you break something and you go to the VA, if you're a lower priority level, as they call it, it's not like they're going to make you go to the back of the line, and you're not going to be treated in a timely manner.

Instead of the priority levels, they're actually there, and they can impact your costs for services at the VA. , if you're part of the VA already, if you use it, you're probably familiar with these priority levels. They range from priority 1 all the way to priority 8. In this case, priority 1 is the highest level.

We'll link to the website with all the criteria for those different groups, so you can always check those out after you listen to them. Now, when it comes to cost and co-pays for the VA, here are some examples of how the VA priority groups can impact your co-pays and your cost. With Urgent Care, if you are a priority group 1 through 5, you have a 0 co-pay for the first three visits of the year, whereas if you are in the lower priority groups, like 7 and 8, you would actually pay a 30 per visit for Urgent Care right away.

It starts on your first visit. Same thing as this is kind of a trend with all these services where the higher priority you might have a co-pay or a cost share. But with primary care and specialist visits, if you are service connected with a disability of 10% or higher, you don't have copays for outpatient care.

So this means primary care specialist, you're not going to pay for those services. Now, if you have less than a 10% service-connected disability, you might pay 15 for primary care and 50 for specialists. In inpatient care, you don't have copays for inpatient services for most priority groups. While those in groups two through eight, as far as priority levels go, they will likely have prescription co-pays.

Just as an example, you may pay 5 for a 30-day supply of generics. However, even if you do pay for prescriptions with the VA, there is a 700 per year maximum on medication co-pays. So although you still have to pay something out of pocket, this is Excellent coverage, but it's not quite 100% free like some people think.

Joanne: But people would love to have that. Most people, 700. Yeah. 

Cameron: Pretty darn low. Yeah, it's a really good deal. It is. So now we're kind of going away from the actual basics of the VA healthcare system. We just wanted to give you that overview Joanne will shift gears here, and we'll talk about what the VA coverage means for you as far as Medicare goes when it comes to Medicare Advantage or choosing a Medicare Supplement.

Joanne: So let's dive into how the actual VA and Medicare actually work together And the simple answer is that they really don't the VA health system does not bill Medicare and Medicare doesn't pay for services provided at the VA facilities now, just because they don't coordinate and work together.

It doesn't mean that you can't have both coverages separately. And in fact, having both coverages mean you actually have more freedom and flexibility inside and outside of that VA health care system. Now remember that. Medicare Part B has a base premium of 164. 90 per month, and that is in 2023. So a lot of people that have access to the VA, wonder if they should actually enroll in Medicare if they plan on relying mostly on the VA health system for their care.

Now, Although, and this is really important, technically you don't have to enroll in Medicare if you solely want to rely on the VA system, but even the VA and this is super important, even the VA themselves on their website say that they encourage those with VA health benefits to enroll into Medicare Part A and Part B as soon as you can.

And here are the reasons why. Number one, you'll have coverage if you need to go to a non-VA doctor or hospital and you're going to, you're just plain old going to have more options. Now VA funding, it can change in the future. You don't know what will happen and what you're going to have access to 10 years from now.

VA coverage is not creditable coverage for Medicare's Part B. And that means that if you don't enroll when you could have signed up for Part B and you want to go get that in five years, you will have at that point a lifetime penalty for five years worth of not having Medicare when you could have been.

So you will get a late enrollment penalty. So that's something really important to, really weigh in your decision when you're, when you're starting in turning 65. VA coverage is considered creditable coverage for Part D prescription coverage. So although you can delay it, The VA says that also getting Part D prescription coverage lets you fill prescriptions from non-VA providers at a local pharmacy.

Now, you must meet specific criteria for emergency services also outside of the VA if it's going to be covered by the VA. So all of those are really good reasons why you should enroll in Medicare Part A and Part B. 

Cameron: Yeah. And again, that is directly from the VA. on their website. Those are the reasons that they actually give as to why you will likely want to have both Medicare Part A and Part B, even if you're eligible for VA health coverage and you plan on using it once you're eligible for Medicare.

 Now if you decide to enroll in Medicare Part A and Part B, As well as also having those VA benefits outside of the Medicare system, should you enroll in Medicare Advantage or Medicare supplement coverage? Again, Medicare supplements are also Medigap plans. This is, of course going to depend on your specific coverage needs, your wants, and your budget.

Anything like that. So we'll highlight some of these examples right now. Usually when it comes to choosing coverage outside of the VA, we recommend thinking of the VA coverage really as a bonus and considering what you want your coverage to look like completely outside of the VA system. So you have to sit there, and you have to think, okay, I have VA coverage, even if I use it all the time or if I use it a little bit, what do I want to have access to outside of that system?

Luckily the Medicare coverage you choose it's not going to negatively impact your VA coverage. Since, again, as Joanne said, they are completely separate systems. No matter what you do, it's not going to impact your ability to go to the VA. Sometimes people want the most coverage possible outside of the VA, and they don't plan to use the VA for many services.

In this case, you might want to consider a Medicare supplement plan. You can even do this with or without Part D prescription drug coverage since, again, these plans, provide comprehensive coverage with Original Medicare, and they will let you see any provider outside of the VA that accepts Original Medicare.

Having VA coverage is not a reason to entirely dismiss the idea of Medigap coverage. In our opinion, it does seem like a lot of veterans that use the VA. They really come to us asking about just some additional coverage outside of it. They kind of have more of an inclination to ask about Medicare Advantage coverage.

This is especially common if you really plan to use the VA for most of your medical and prescription needs. Once you're on Medicare, in this case, you may want to consider a Medicare Advantage plan because when you do go outside of the VA, these plans typically come with low. Monthly premiums, they can provide prescription coverage that would allow you to get prescriptions from doctors outside the VA when you're in the VA; it's not always easy to if you just need antibiotics or pain medicine or something like that, it's not easy to just go to a civilian doctor and try to get those medications.

You have to go through the VA, and sometimes you don't want to deal with that, and that's where Medicare Advantage can come into play. Now, Medicare Advantage plans, they're also well known for the extra benefits that they provide that are not normally covered by original Medicare or even the VA.

Not all VA-eligible veterans are eligible to get services like dental at the VA, just like Joanne mentioned at the beginning. So it's worth looking at Medicare Advantage plans to see if there are unique coverages or unique extra benefits that fit you. And more than ever, you might even see that there are companies and Medicare Advantage plans targeted to veterans. They're always worth considering. 

Joanne: now, let's shift gears. We're going to shift over to Medicare and TRICARE for Life.

Okay. Thank you. So what is TRICARE for LIFE? TRICARE for LIFE is an essential military healthcare program that primarily serves retired members of the military and their dependents. , let's talk about eligibility. Who is eligible for TRICARE for LIFE? Now, the defining factor of eligibility for TRICARE for LIFE is enrollment in both Medicare Parts A and B.

It's designed to benefit retired military personnel who have served for 20 years or more.

Cameron: I just want to highlight that real quick because it's very important to understand that this is for retired military personnel, not just people that got out of the military after a set period of time. Like myself, I did eight years in the reserves. That is very far from a retirement of 20 years. So if you know somebody that just had one tour of duty or they had one contract, and they were in the military for four years. Getting out of the military is not the same as retiring from the military. I just want to highlight that because it's a huge differentiator for eligibility. 

Joanne: And how does Tricare for Life work with Medicare? Now, Tricare for Life will provide a premium free wraparound to original Medicare coverage, as well as built-in prescription coverage. Tricare for Life provides very comprehensive coverage with Medicare, and the coverage can commonly be thought of as a Plan F, which is a Medigap Plan F. It's not a Plan F, but it's a little bit like that. In this case, it has no monthly premium for you, and it has added prescription coverage.

Cameron: Now, what you might be wondering is how does TRICARE work or not work with Medigap plans or Medicare Advantage plans? So, if you are eligible for TRICARE for Life, you are definitely not immune from all of the advertisements about Medicare Advantage plans or even your friends telling you about the latest and greatest coverage that they've gotten, and this is the same for Medicare supplement plans.

So do you need these coverages if you're eligible for TRICARE for Life? The answer is no. You really don't need it, but in some circumstances, you might want it, and you might want to consider them. So let's talk about it. Medicare Supplements, again, also known as Medigap plans. Let's make this really simple Yes, there's always a point one percent chance of a weird situation out there, and we don't like to say things in blanket statements, but To make things pretty simple, in almost no circumstance will you want or need a Medicare supplement if you have Tricare for Life. Tricare for Life already functions, just like Joanne said, as a no-cost Medicare supplement plan.

So purchasing another Medicare Supplement plan it's just going to duplicate Your coverage, and that's the best-case scenario. The worst case is you're wasting money on added monthly premiums you don't have to spend. So make it pretty simple with the Medigap plans. You don't need those.

And the same goes with part D. You're not going to add part D to try to care for life in almost any circumstance. Now, Medicare Advantage plans are a little more enticing. Again, we've talked about their low premiums and extra benefits. So what about Medicare Advantage plans? Whether or not you want a Medicare Advantage plan, it will be a different calculation and decision for every person.

Again, these plans are private alternatives to original Medicare. Enrolling in a Medicare Advantage plan will now be your primary coverage instead of Original Medicare. Now Tricare for Life will still remain secondary, but again, that primary coverage will actually be impacted and change.

So a really important thing to consider if you do want a Medicare Advantage plan with Tricare for Life. We typically almost always recommend at least getting a plan with no prescription drug coverage. The reason for this is we don't want it to negatively impact your TRICARE for LIFE prescription coverage that is built into your coverage.

And we want to make sure you can still use the TRICARE for LIFE prescription home delivery program. So this is actually getting medications through the mail at low to no cost. And also, when it comes to TRICARE for Life with a Medicare Advantage plan, we recommend that at least consider a PPO plan initially instead of an HMO.

Just a brief overview. If you go to a provider out of network with a PPO, those plans may cover you outside of the network TRICARE. In that case, however, if you go to an HMO plan and go outside of the network, if it's not an emergency or urgent service, it's probably not going to be covered outside the network.

And if it's denied by the HMO, TRICARE for Life also does not have to cover those out-of-network costs. So some pros with having potential Medicare Advantage coverage with Tricare for life. You might be able to get a reduction in your Part B premium. A lot of people have Tricare and different levels of Tricare before they are eligible for Medicare, and the premiums are very low for that coverage.

So some people are. I'm kind of shocked or confused as to why do I have to pay $164.90 per month?, at least for Medicare, when I didn't have to pay that before to have TRICARE for life. So this is where a reduction in Part B premium can be enticing because it can help, you know, potentially lower that and Absorb some of that shock from having to pay for Medicare also medicare advantage plans. They do typically have extra benefits that are not covered by Original Medicare, And although Tricare for Life does provide dental coverage that you can purchase, It is not built indirectly to the program for free.

Now, of course, there are cons to this route. We're not saying everybody should have a medicare advantage plan with tri care for life. If anything, I'd say a minority of people do when it's all said and done, but the Medicare Advantage plan, it will create a network of providers that you will likely have to use that does not exist when you have Medicare and TRICARE for Life.

This can also come with prior authorization, which means you are required to get prior authorization before treatments. Or procedures can be done. You might need referrals to see specialists. And finally, although it's less common if you go to a provider that refuses to bill your TRICARE for LIFE after your Medicare Advantage plan, you might have to fill out paperwork or request reimbursement from the TRICARE for LIFE program.

And overall, the billing is just not as seamless. So that's pretty much everything as far as an overview of Tricare for life. Now we'll shift again to the last topic, CHAMPVA, which is very similar to Tricare for Life, but we'll have Joanne talk about that. 

Joanne: Well, and luckily when it comes to understanding CHAMPVA, it functions a lot.

And very similar to TRICARE for Life, which we just talked about. So let's go right into who is eligible for CHAMPVA. If you have CHAMPVA and qualify for Medicare at any age, you must have both Medicare Part A and Part B to continue your CHAMPVA eligibility. CHAMPVA coverage is typically for spouses and dependents of a veteran permanently disabled due to a service-connected disability or disabled veterans that are now deceased.

So eligibility will depend on their disability level and the timing of death. So we're going to link to those details in the show notes. Unlike the name implies, CHAMPVA and Medicare cannot be used at the VA. The CHAMPVA and the Medicare fact sheet will link specifically states that CHAMPVA beneficiaries with Medicare cannot use a VA medical center because Medicare will not pay the medical center for its services.

So if you're currently being seen at a VA medical center, you will be entitled to Medicare soon. You'll have to find a different provider, so please be aware of that. How does CHAMPVA work with Medicare, then? So it will act as secondary coverage to Medicare, just like TRICARE for Life did, and it provides creditable prescription drug coverage.

And just like TRICARE for Life, CHAMPVA will essentially function as a free Medicare supplement. Again, it's not a Medicare supplement, but it will function as one. And it will allow you to see any provider nationwide that accepts original Medicare. It also provides comprehensive drug coverage provided by the mail order program called Meds by Mail, which is different than the TRICARE for Life Home Delivery Program, but it's an excellent option.  

Cameron: Yeah, again, TRICARE for Life and CHAMPVA they function very similarly; distinct differences to notice, and it's mostly eligibility and a couple of things like those Meds by Mail versus the TRICARE Home Delivery Program. The same thing kind of goes when it comes to talking about CHAMPVA with or without Medicare Advantage or Medigap coverage.

I'll go a little bit quicker through this since; again, it is very similar to what we just talked about. So just like those eligible for TRICARE for Life, if you're eligible for CHAMPVA, you might be wondering Do you want a Medicare supplement or do you want a Medicare Advantage plan? Again, I'll make it easy.

You likely don't want a Medicare supplement plan if you have CHAMPVA. The same goes for having Part D coverage. Same thing with TRICARE. It just duplicates your coverage. You're likely wasting money on premiums you shouldn't be paying, and you're not getting a benefit. Now, Medicare Advantage, on the other hand, can come into play.

So just like with TRICARE for Life, Medicare Advantage plans are still private alternatives to Original Medicare. So same thing, the Medicare Advantage plan will be your primary coverage instead of Original Medicare, and CHAMPVA can be your secondary coverage. So if you choose this option, again, we recommend getting a plan without prescription drug coverage in almost all cases so that you don't lose your meds by mail coverage.

To be very clear, if you do sign up for Medicare Advantage coverage with drug coverage, you will lose that med by mail coverage, at least For the time being while you're in that plan. And it's not always that easy to get it back. You will get it back, but it can take some time. Also, unlike Tricare for Life, it's important to know that with Champ VA, they will typically not pay out-of-network charges, even with a PPO plan.

It's not about choosing PPO versus HMO. It's really about being extra careful to make sure the providers you want access to are part of the Medicare Advantage plan you are enrolling in. So some pros, again, are the potential reduction of that Part B premium with a Medicare Advantage plan, as well as extra benefits not covered by Original Medicare or CHAMPVA.

And then the cons, of course, they are the same as what we talked about. You might have a network of providers you don't have with Medicare. Prior authorization can be an issue. You may need referrals to see specialists. And, of course, claims, although rare, can be an issue if your doctor is unwilling to bill CHAMPVA as secondary to your Medicare Advantage plan.

 Joanne can round things out here with a brief recap. 

Joanne: So, recapping the VA health benefits, VA benefits are unique because they're separate from Medicare, and they don't coordinate the coverage with Medicare. So think about how much Or little you plan to use the VA services if you're eligible and think about what you want your coverage outside of the VA to look like and consider enrolling in a Medicare Advantage plan or a Medicare supplement plan, just like any other Medicare beneficiary would try to care for life and champ VA.

Here are some things to consider. Consider adding nothing and keep Original Medicare and Tricare for Life or you can get quotes and options for Medicare Advantage plans available in your county. That doesn't provide prescription drug coverage. There is no need to enroll in a Medicare supplement.

So overall, regarding TRICARE for Life or CHAMPVA coverage, if you want to avoid any possible hassles or restrictions, you may find it worth not enrolling in a Medicare Advantage plan. But if you're familiar with and comfortable with the potential pitfalls, it can certainly be a viable option that you can consider.

But remember, with all options, consult a broker knowledgeable about how your veteran benefits interact with Medicare and other health insurance. That's important. 

Cameron: So if you're eligible for any of the coverage we talked about in this episode, thank you for your and your family's service in the armed forces.

We want to make sure you can maximize the benefits that you are entitled to, to the best of your ability. So hopefully, this episode has allowed you to do just that. As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can also find more Medicare content from us.

It's by going to YouTube and searching Giardini Medicare. And lastly, you can now check out our free online course, gmedcourse.com or gmedcourse.com. Thanks for listening, and have a great day.