Veterans, Medicare and
Medicare Insurance
CALIFORNIA VETERANS
23 million veterans of the United States armed
forces may be eligible for a broad range of programs an...
VA Health Care
U.S. Department of
Veterans Affairs
How VA Health Care Works
VA determines eligibility for the comprehensive medical benefits
package through a patient enroll...
Tricare and Tricare For Life
TRICARE and TRICARE For Life Overview
Active Duty
TRICARE
Retired from
Service
TRICARE
When age 65 and
have Parts A & B
en...
TRICARE, TRICARE For Life and Medicare Services
For Services
covered by
both Medicare
and TRICARE
Medicare pays
first
TFL ...
TRICARE, TRICARE For Life and Medicare Services
For services not
covered by
Medicare or TFL
Medicare
and TFL
pay
nothing
Y...
Affordable Care Act (Obamacare) and VA
Health Administration
The provisions of the Affordable Care Act (ACA) upheld by
the...
What Do Veterans Think Of VA Health Care?
One point of view: Time Magazine
Report: ―You can expect VA’s highly qualified a...
What Do Veterans Think Of VA Health Care?
Other Headlines:
―Veterans Wait for Benefits as Claims Pile Up‖ (From The
New Yo...
What Do Veterans Think?
Corpus Christi, Texas
 CORPUS CHRISTI — Disabled veteran Roy Stamper, 54, spends
his days in fron...
Our Country’s Health Insurance Program
What is Medicare?
Medicare is our country’s health insurance program
for people age 65 or older. Certain people younger
th...
Medicare At A Glance
Original
Medicare
Part A
Hospital
Part B
Doctors
Medicare
Insurance from
private companies
Part C plu...
Disability Planner:
Medicare Coverage If You Are Disabled
To qualify for Social Security disability benefits, you must
fir...
Key Question That Veteran’s
Should Ask About Medicare
If I have good medical coverage from the Veterans Affairs health
pro...
Reasons #1and #2
1. VA health coverage is not set in stone and is not the same
for everyone.
The VA assigns enrollees to d...
Reason #3
3. Part B late penalty.
If in the future, after you are well past 65, you happen to lose
VA coverage, or you dec...
Reason #4
4. Prescription drug coverage Part D benefits.
Your prescription drug coverage in the VA is much better than
Med...
Reason #5
5. Enrolling in Medicare Part A and Part B qualifies you to
enroll in Part C Advantage Plan which includes Part ...
Which Veterans Should Examine the Part C
Advantage Plan Possibilities?
Veterans who will turn 65 this year.
Veterans who a...
Thank You
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Veterans and Medicare Overview

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Important educational information regarding veterans and their Medicare benefits. Many veterans do not know some of this important information shown in this presentation.

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  • There are possibleholes in Tricare coverage.
  • Veterans and Medicare Overview

    1. 1. Veterans, Medicare and Medicare Insurance
    2. 2. CALIFORNIA VETERANS 23 million veterans of the United States armed forces may be eligible for a broad range of programs and services provided by the U.S. Department of Veterans Affairs (VA) The largest number, nearly 2,200,000 veterans, live in California. VA Expenditures in CA: $9 Billion Department of Veteran Affairs
    3. 3. VA Health Care U.S. Department of Veterans Affairs
    4. 4. How VA Health Care Works VA determines eligibility for the comprehensive medical benefits package through a patient enrollment system. The system is based on Priority Groups 1 through 8. Eligibility for VA benefits is based on each Veteran’s unique eligibility factors. Veterans must apply to obtain access to VA health care benefits. Once the application is successfully processed, the VA will notify the Veteran of the priority group assignment, the benefits the Veteran is eligible for and information about how to access the VA health care. If not accepted the Veteran can appeal the decision. Veteran’s Health Guide: Department of Veteran’s Affairs
    5. 5. Tricare and Tricare For Life
    6. 6. TRICARE and TRICARE For Life Overview Active Duty TRICARE Retired from Service TRICARE When age 65 and have Parts A & B enrolled in TFL
    7. 7. TRICARE, TRICARE For Life and Medicare Services For Services covered by both Medicare and TRICARE Medicare pays first TFL pays the remaining co- insurance of TFL covered services For services covered by TRICARE but not Medicare TFL pays first and Medicare pays nothing You must pay the TFL deductible and cost shares For services covered by Medicare but not TRICARE Medicare pays first and TFL pays nothing You must pay the Medicare deductible and coinsurance
    8. 8. TRICARE, TRICARE For Life and Medicare Services For services not covered by Medicare or TFL Medicare and TFL pay nothing You must pay the entire bill
    9. 9. Affordable Care Act (Obamacare) and VA Health Administration The provisions of the Affordable Care Act (ACA) upheld by the U.S. Supreme Court will not affect the current role the Department of Veteran’s Affairs (VA) has in the lives of America’s Veterans. We will continue to provide Veterans with high quality comprehensive health care and benefits they have earned through their service. VA health care does not change as a result of the ACA. --- United States Department of Veterans Affairs
    10. 10. What Do Veterans Think Of VA Health Care? One point of view: Time Magazine Report: ―You can expect VA’s highly qualified and dedicated health care professionals to meet your needs, regardless of the treatment program, regardless of the location.‖ Article: ―How Veterans' Hospitals Became the Best in Health Care‖ (http://www.time.com/time/magazine/article/0,9171,1376238,00.html#ixzz2KTaM9GIx From TIME Magazine, 2006)
    11. 11. What Do Veterans Think Of VA Health Care? Other Headlines: ―Veterans Wait for Benefits as Claims Pile Up‖ (From The New York Times, Sept. 2012. Taking up to two years to process.) “Hundreds of thousands of war vets still waiting for health benefits” (From Phoenix CNN Health, October 2012) ―VA works to resolve problems after doctors, veterans complain about sluggish reimbursements for care‖ (By Rhiannon Meyers, Posted March 18, 2012 at 6:40 a.m., updated March 18, 2012 at 10:36 a.m.)
    12. 12. What Do Veterans Think? Corpus Christi, Texas  CORPUS CHRISTI — Disabled veteran Roy Stamper, 54, spends his days in front of a television, hobbling around his apartment on a cane and managing the constant sharp pain and numbness in his artificial hips with daily morphine pills.  For months, Stamper tried to find a local orthopedic surgeon to take a look at his hips and diagnose the pain, but over and over again, he found that doctors simply refused to accept a voucher that promised reimbursement for care from the U.S. Department of Veterans Affairs.  Some local doctors have stopped seeing veterans because the VA has taken too long to reimburse them for the treatment.
    13. 13. Our Country’s Health Insurance Program
    14. 14. What is Medicare? Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities, permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. --- Social Security Administration
    15. 15. Medicare At A Glance Original Medicare Part A Hospital Part B Doctors Medicare Insurance from private companies Part C plus benefits Part D Prescription Drugs
    16. 16. Disability Planner: Medicare Coverage If You Are Disabled To qualify for Social Security disability benefits, you must first have worked in jobs covered by Social Security. Then you must have a medical condition that meets Social Security's definition of disability. In general, Social Security pays monthly cash benefits to people who are unable to work for a year or more because of a disability. The Social Security Administration automatically enrolls you in Medicare after you get disability benefits for two years. The two parts of Medicare they enroll you in are hospital insurance (Part A) and medical insurance (Part B). ---Social Security Administration
    17. 17. Key Question That Veteran’s Should Ask About Medicare If I have good medical coverage from the Veterans Affairs health program, do I need to enroll in Medicare Part A and Part B when I turn 65 and enroll in Part C and Part D? Answer: (AARP Bulletin, May 2012) You don’t have to enroll in Medicare, but there are 5 good reasons why you should definitely enroll in Parts A and B and look into enrolling in a Part C Advantage Plan that includes Part D and other benefits. In fact, the VA strongly recommends that all veterans who have VA health care also enroll in Medicare as soon as they become eligible (unless they have other coverage – for example, from an employer or union.
    18. 18. Reasons #1and #2 1. VA health coverage is not set in stone and is not the same for everyone. The VA assigns enrollees to different priority levels according to various factors. If federal funding drops, or doesn’t keep pace with costs some veterans in the lower priority levels could lose VA coverage entirely. 2. Having both Medicare (Parts A, B, C and D) and VA benefits widens your coverage. If you need to go to a non-VA hospital or doctor, you are automatically covered under Medicare Part A (hospitalization) and Part B (doctors and outpatient services) –whereas with A coverage alone, you may end up having to pay the full cost yourself. The Part C Advantage Plan would cover the out-of-pocket costs. The VA has rules about who qualifies for coverage at non-VA facilities, even in emergencies. -- AARP Bulletin, May 1, 2012
    19. 19. Reason #3 3. Part B late penalty. If in the future, after you are well past 65, you happen to lose VA coverage, or you decide that you need Medicare and are not already signed up for Part B, you would pay a late penalty to enroll at that time. The penalty permanently adds an extra 10% to your monthly premium for each year that you delay. If you wait 5 years to sign up for Part B and have had no other health insurance apart from VA’s, you would pay 50% more for the same coverage for the rest of your life. -- AARP Bulletin, May 1, 2012
    20. 20. Reason #4 4. Prescription drug coverage Part D benefits. Your prescription drug coverage in the VA is much better than Medicare’s, so you don’t need to join a Part D drug plan, and you won’t incur a Part D late-enrollment penalty if you lose your VA coverage in the future. Still, if you decide to have Part D (which is part of the Advantage Plan, Part C or purchased by itself) you would have the flexibility of being able to use one or the other. You could get prescriptions from non-VA doctors and fill them at local retail pharmacies instead of going to a VA doctor for a prescription and having it filled through the VA mail order service and may be able to obtain medications that the VA doesn’t cover. -- AARP Bulletin, May 1, 2012
    21. 21. Reason #5 5. Enrolling in Medicare Part A and Part B qualifies you to enroll in Part C Advantage Plan which includes Part D prescription drug coverage and other benefits. Part C Advantage Plans in many areas are offered at a $0 (zero) premium fee. For no additional out-of-pocket monthly costs, veterans can have health coverage from two different sources. Veterans can choose which local or VA hospitals and/or doctors to visit that will best fit their medical needs. This is an advantage that no other group of citizens enjoy. Veterans are encouraged to examine the Part C benefits to determine if these will a plus for their rising health costs. -- AARP Bulletin, May 1, 2012
    22. 22. Which Veterans Should Examine the Part C Advantage Plan Possibilities? Veterans who will turn 65 this year. Veterans who are 65 and older who have VA health coverage and are still working for an employer or union and have additional coverage and will be retiring soon. Veterans who are younger than 65 and are on disability. Veterans who have TRICARE For Life and Medicare but have a medical need that is not covered by TFL.
    23. 23. Thank You

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