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If you or your spouse are a veteran, then you are likely aware of your VA medical benefits. For many veterans, VA health care is a badge of honor — a well-earned benefit intended to reward service. While VA benefits are comprehensive, many veterans also either have private insurance or are qualified for Medicare. For these veterans, knowing which plan covers their medical needs and which coverage is best for a particular illness or condition is crucial. While the VA provides benefits for veterans, the federal government also provides health care to seniors. Older veterans might not know which plan offers the best coverage and how to coordinate these two systems best.
Health insurance is, of course, an essential part of life. Medical care can be expensive, and preventive care is the key to good health, longevity, and avoiding severe conditions as we age. Health insurance can also be complicated, especially when dealing with multiple insurance companies and programs. Veterans sacrifice much for their country, so it's crucial for them to be able to maximize their benefits. Coordinating benefits makes sure that veterans get the care they need and deserve while minimizing out-of-pocket expenses. Before sorting out the differences between VA medical benefits and Medicare, let's get a better understanding of how VA benefits work.
Understanding Veteran Medical Coverage
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The United States Department of Veterans Affairs (VA) has a long history and a crucial role in the development of our nation. The organization hasn't always had the same name or organizational structure, but its focus on assisting veterans has remained a constant. The VA's primary function is to support veterans in their lives after service. Healthcare is a crucial component of this support.
VA Medical Benefits
The VA provides comprehensive medical benefits. Benefits aim to provide resources for veterans to treat illnesses and injuries and prevent problems in the future. VA medical benefits can also improve a veteran's ability to function, enhancing the quality of life. Services provided include health exams, education, immunizations, counseling, surgeries, medical treatments, and acute and specialized care.
Qualification For Benefits
VA benefit qualification is complicated. To qualify for VA medical benefits, one must generally be a veteran or, in certain circumstances, a spouse, surviving spouse, or dependent of a veteran. The VA has a priority system. However, that adds layers of complexity to qualification. Under the priority system, for example, a veteran with a service-related disability or condition receives the most comprehensive care. Take, for instance, a veteran seriously wounded in battle. Service-related injuries can result in lifelong conditions, so it is fitting that the VA moves these patients to the head of the line when it comes to receiving medical care. Veterans without a service-related injury are also qualified, however, their benefits may be less comprehensive.
In most cases, eligibility requires an honorable discharge, but again, complex rules govern coverage. A service member could complete a period of service under honorable conditions, then reenlist for a later period that terminates dishonorably. In such a case, the VA might award benefits based on the service period resulting in honorable discharge.
Spouses And Dependents
Benefits can extend to people other than a servicemember. Family members and dependents of a veteran who dies in the line of duty or as a result of a condition related to service may be eligible for VA medical benefits. An example of this is in the case of a deceased veteran's spouse who might need assisted living care at an advanced age. If the veteran's death is service-related, the surviving spouse might be eligible for VA aid and attendance, a benefit that provides in-home care.
What VA Might Not Cover
For the most part, VA medical facilities such as VA hospitals and clinics administer VA medical benefits. A patient's veteran status is irrelevant when obtaining medical care at a non-VA facility, such as a private hospital. There are instances when the VA can approve treatment at a non-VA facility, but this would most likely be for specialized services.
Although VA medical benefits provide a range of coverage for many veterans, the VA cannot cover every single condition for every veteran. The VA might not include dental, vision, and other specialized treatments. In general, VA health coverage is not a blanket benefit for all veterans. The priority system can mean that coverage can change. Also, the VA is subject to federal funding, which can change. Through a combination of the priority system and changes in funding, medical benefits could reduce, requiring veterans to look elsewhere to cover their health care expenses. For many older veterans, Medicare may fill these gaps in coverage.
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Medicare is the national health care system for seniors, younger people with disabilities, and those with end-stage permanent kidney failure. Like VA medical benefits, Medicare can be confusing. The first puzzling part is its name. People often confuse Medicare with Medicaid. These two programs both emerged from federal legislation in the 1960s that aimed to improve access to healthcare for individuals with less ability to afford private health insurance. Medicare is age and condition based. Income is not a factor in determining eligibility. Income can, however, impact monthly premiums under Medicare. Medicaid is a federal and state program that provides health care for lower-income individuals.
Medicare provides comprehensive benefits for qualified recipients. To determine benefits, an eligible recipient must look at the various Medicare plans. Medicare comes in two main "parts" and a supplemental plan.
Medicare Part A
Part A Medicare is hospital insurance. This plan covers medically necessary services in a hospital and skilled nursing facility. Part A can also cover some aspects of home health care and hospice care. "Medically necessary" means that hospitalization is the result of doctor's orders. There are some additional conditions for coverage. The hospital must accept Medicare, and in some cases, the hospital will have to review a patient's status to approve hospitalization.
Medicare Part B
Part B is Medicare's general medical insurance. This Medicare part covers doctor's services, preventive care, outpatient services at a clinic or hospital, radiology, testing, outpatient mental health care, and more. For example, Part B covers a flu shot, but if you have a severe case of the flu that requires inpatient hospitalization, Part A will cover the expenses.
Beyond Parts A and B, things can get very complicated, with the interworkings of private health insurers. Part C, or Medicare Advantage, is offered through private insurers who follow Medicare rules. Medicare Part C provides the coverage of Parts A and B with some additional coverage, such as vision and dental. Part D is a prescription drug plan, and Medigap offers supplemental insurance for expenses that the other Parts of Medicare do not cover. Each of these many moving parts can make up a comprehensive health plan for those with varying needs.
Qualification For Medicare
As we initially stated, Medicare covers those over 65, younger individuals with certain disabilities, and those with specific kidney disorders. Age-based qualification is relatively simple. All Americans become eligible upon their 65th birthday. There are some rumblings in the government about shifting this age to 67, but this has yet to be changed. In addition to age, a recipient of Medicare benefits must be a United States citizen. A permanent legal resident, who has resided in the US for the past five years is also qualified. As with many federal programs, there are some other less-common qualification methods.
The age-based condition for Medicare coverage is likely most relevant to veterans. Some veterans may have qualifying disabilities, but a large number of veterans reach the age of 65. So, there are many people each year evaluating the best way to maximize both VA and Medicare benefits.
Can You Combine VA Medical Benefits With Medicare?
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Whether or not VA medical benefits and Medicare work together is a common question. Is one better than the other? Are there reasons to use VA benefits when the same care can be had from Medicare? The short answer is that the two plans are not interchangeable, but each may provide care options that the other omits. Because of this, it is essential to know the benefits and limitations of each plan.
Someone can be both VA and Medicare qualified. A 70-year-old with an injury from active duty is going to be on a priority list for VA benefits, and would, therefore, receive the most comprehensive care from a VA facility. But, this person will also be age-eligible for Medicare. This situation is the most basic coverage overlap. However, there are several reasons why someone would pick and choose between VA and Medicare.
Both Cannot Be Used Together, But If VA Doesn't Cover, Medicare Might Step In
In general, you cannot use both Medicare and VA simultaneously. In other words, VA benefits cannot be used to cover a gap in Medicare coverage or vice versa. This is because VA benefits are only available in a VA facility, under most circumstances. However, if the VA doesn't cover a particular treatment, a patient may be able to use Medicare to cover the expenses at a non-VA facility. This may also be beneficial in the event a veteran's priority status with the VA changes, making Medicare a better economic choice.
Medical Care Outside Of A VA Facility
Also, not every geographic area is served by a VA facility. There are 170 VA hospitals and over 1,000 outpatient care centers, so for many people, there are VA care options. For those not geographically close to a VA center, however, using Medicare may be the best option. While not all doctors accept Medicare, an estimated 93 percent of healthcare providers do. With Medicare eligibility, patients may find that they have more options for their care.
Understanding Out Of Pocket Costs
Before making a decision about which coverage to use, a patient should know exactly what their out-of-pocket expenses will be. Veterans should reach out to the care coordinator at their local VA center and should be aware of their premiums and co-pays, if any, under both their VA plans and Medicare. These expenses can ultimately provide a crucial turning point for a healthcare decision. Cost should also be weighed against quality of care.
Using VA Medical Benefits With Medicare For Maximum Coverage
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While VA and Medicare benefits may not be interchangeable, a care plan should maximize services and minimize out-of-pocket costs by coordinating care under both plans. For example, Medicare Part A and the VA may each provide the same level of inpatient hospital care, but VA's outpatient services may be cheaper. Alternatively, the VA might not cover services that are available under Medicare Parts B, C, or D. Learn your options and be sure to ask for assistance. Sometimes, the solution is right in front of you but needs to be uncovered first.