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Creditable coverage means health care coverage under a group health plan, individual health insurance, or a government sponsored health program, including enrollment in the VA health care system.
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Continuous enrollment in the VA health care system provides you with “creditable coverage” needed for certain purposes. For example, as of July 1, 2007, all residents of the Commonwealth of Massachusetts must have creditable coverage. Massachusetts residents will be required to show proof of creditable coverage when filing state tax returns in 2008. Other examples of why certification of creditable coverage may be important are when enrolling with a new private health insurance issuer under Title 1 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or for purposes of the Medicare prescription drug program (“Medicare Part D”).
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Only individual veterans may enroll in the VA health care system. Dependents and family members are not covered under the veteran's enrollment.
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Typically, enrollment in the VA health care system is continuous. A veteran does not need to disenroll from VA to enroll in other health plans, they may have either or both. A veteran who decides to disenroll from VA may not be able to re-enroll in VA later if VA is not enrolling all priority groups. There are a few instances where a veteran may be disenrolled:
- The veteran is determined not eligible for enrollment
- VA takes action that causes the veteran to be disenrolled
- The veteran requests to be disenrolled.
VA will provide a letter to the veteran that he or she is disenrolled for VA health care. If you lose creditable coverage from VA or another provider, you may be subject to financial penalties or benefit restrictions if you don't replace the coverage within a specific time period.
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The Massachusetts Health Reform Act does not alter the provision of health care benefits to veterans. Veterans enrolled in the VA health care system may continue to receive their health care from VA. Additionally, their enrollment in VA constitutes "creditable coverage" in satisfaction of the Massachusetts' individual health coverage mandate. Massachusetts' veterans interested in acquiring additional health care coverage may wish to review available health insurance options by contacting the Commonwealth Health Insurance Connector Authority at 1-877-MA-ENROLL (1-877-623-6765), or www.mahealthconnector.org. For more information about this notice or VA health care benefits, contact the VA Health Benefits Call Center toll-free at 1-877-222-VETS (8387), or visit the VA website at www.va.gov/healtheligibility or your local VA medical facility.
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VA does not recommend that veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care. Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to priority levels based on a variety of eligibility factors, such as service-connection and income. There is no guarantee that in subsequent years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups. This could leave veterans, especially those enrolled in one of the lower priority groups, with no access to VA health care coverage. For this reason, having a secondary source of coverage may be in a veteran's best interest.
In addition, a veteran may want to consider the flexibility afforded by enrolling in both VA and Medicare. For example, veterans enrolled in both programs would have access to non-VA physicians (under Medicare Part A or Part B) or may obtain prescription drugs that are not on the VA formulary if prescribed by non-VA physicians and filled at their local retail pharmacies (under Medicare Part D).
Veterans should also be mindful of the late enrollment penalties in Medicare Part B and Part D that are imposed on those who do not enroll in Medicare during their initial enrollment period. VA health care is recognized as creditable coverage for Medicare Part D (prescription drug program) but it is NOT creditable coverage for Part B (outpatient health care, including doctors’ fees). So although a veteran may avoid the late enrollment penalty for Part D by citing VA health care enrollment, that enrollment would not help them avoid the late enrollment penalty for Part B.
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