While Veteran’s Affairs (VA) health coverage and Medicare Part D are both Government Health Programs, there are distinct features and circumstances to take note of when deciding whether to maintain one form of coverage or enroll in both forms. In this article, we will try to help address common questions we have received, dispel common misconceptions, and assist you and your patients when weighing whether to combine coverage or not.
I have VA Benefits, so can I enroll in a Medicare Part D Plan? Why would I need a Medicare Part D Plan?
Yes, individuals that receive benefits through the Department of Veteran’s Affairs can also receive coverage with Medicare. While VA benefits do offer credible drug coverage, under certain circumstances it might be beneficial for an individual to at least review and then decide whether or not to enroll in a Medicare Part D plan.
We recommend comparing the costs and benefits that come with each form of prescription coverage. Broadly speaking, VA beneficiaries will not be responsible for a monthly premium or copay for most medications; however, for certain medications the patient will be responsible for a co-pay, albeit a smaller cost compared to the broader market.
As mentioned, there are certain circumstances where we would encourage an individual to at least consider enrolling in a Medicare Part D plan:
Proximity: they live closer to a retail pharmacy that is in-network for a Medicare Part D plan than a VA facility
Formulary: similar to all prescription drug plans, VA benefits are subject to a formulary and for certain patients, this formulary may be too restrictive or may not cover all of their medications
Residence: they live in a non-VA nursing home and it is easier to fill their prescriptions with the associated LTC pharmacy
Extra Help: they qualify for a certain subsidy that would result in lower copays and annual out-of-pocket costs
Expanded network: similar to enrolling in Original Medicare (Parts A and B), enrolling in a Part D plan increases the number of providers an individual can see. They will have the flexibility to fill prescriptions at both VA facilities and local retail pharmacies and they can also fill prescriptions from non-VA doctors at these local retail pharmacies.
It is important to remember that VA benefits can only be used at VA facilities and they will not be accepted any place else. Additionally, VA benefits will not cover any cost-sharing portions of a Medicare plan, including a plan’s premium, deductible, or any copays the individual is responsible for.
If I enroll in a Medicare Part D plan, will I lose my VA Benefits/TRICARE coverage?
No, an individual will not lose their VA Benefits if they were to enroll in a Medicare Part D plan. Even though both health providers are run by the United States federal government, the Medicare and VA systems are separate entities and they do not coordinate or communicate with each other. Enrollees will be provided with separate ID and medical cards that will need to be used at each respective facility.
Do VA Benefits/TRICARE count as credible coverage? Will I be impacted by the Medicare Part D Late Enrollment Penalty if I lose my VA Benefits/TRICARE coverage?
Yes, receiving drug coverage from the Department of Veterans Affairs and/or TRICARE is considered a form of credible prescription drug coverage. It is important that whomever is providing the credible prescription coverage informs their beneficiaries that their coverage is considered credible coverage for the following year, as this is subject to change. This should be reviewed and confirmed annually.
If someone does lose their prescription drug coverage, they will have roughly 2 months (63 days) to enroll in a Medicare Part D plan before they are subject to the Medicare Part D late enrollment penalty (LEP). If they do not enroll in a Medicare Part D plan within this grace period, they will be subject to the penalty after enrolling in a future plan.
However, it is important to remember that enrolling in Original Medicare and Medicare Part D plans are subject to hard and fast rules. For example, if someone is not enrolled in a Part B plan before losing coverage, they may need to wait for the next Medicare Part B Open Enrollment period, at which point they would be liable for late penalties being added to their monthly premiums.
Can a VA pharmacist fill a prescription from a non-VA medical provider? Vice versa?
The VA will usually only fill medications prescribed by VA providers, subject to the formulary. Under certain circumstances though, the VA will fill medications prescribed by a non-VA provider only if the following criteria is met:
The individual is currently receiving VA health benefits
The individual has an assigned Primary Care Provider
The individual has provided their VA health care provider with medical records from their non-VA provider
Their VA health care provider agrees with the medication prescribed by their non-VA provider.
If you have any questions regarding your VA benefits, including changing your coverage, current drug formulary, services offered, etc., we recommend calling the U.S. Department of Veteran Affairs at 1-800-827-1000 or visiting the closest VA facility and/or pharmacy.