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No, Medicare's prescription drug coverage is completely voluntary.
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Yes
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A spouse of an enrolled veteran can obtain VA benefits only if the spouse is a qualified veteran herself or himself. A spouse must determine whether enrollment in a Medicare Prescription Drug plan is a good idea without regard to the enrolled veteran's status. Spouses covered by CHAMPVA should contact CHAMPVA for information at 800-733-8387 or visit their web site at http://www.va.gov/hac/forbeneficiaries/.
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Most veterans are currently charged $8 for each 30-day or less supply of medication provided by VA for treatment of conditions that are not service-connected. For veterans enrolled in Priority Groups 2 through 6, the maximum copay for medications that will be charged in calendar year 2008 is $960.
There are no copay caps for veterans in Priority Group 7 and 8. Also, VA does not have annual deductible requirements.
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The Medicare copay may vary. If the beneficiary has low income and has the full Medicare low income subsidy, the Medicare copay will be $1 or $2 for generics and preferred prescription drugs, and $3 or $5 for preferred brand name drugs. Other low-income subsidy eligible individuals not eligible for the full subsidy may receive a partial cost sharing subsidy resulting in a $50 deductible and 15% coinsurance. The Medicare copay will be for each prescription, whether it is for a 30, 60, or 90 day supply of medication. If the beneficiary does not have Medicare's extra help for low-income individuals, the cost sharing for a prescription will vary according to the selected drug plan. For the standard benefit, here is how the coverage works:
After you pay the $250 yearly deductible, you pay 25% of your yearly drug costs after the $250 deductible until you reach $2,250 in drug costs, and your plan pays the other 75% of these costs. Then you pay 100% of your next $2,850 in drug costs (known as the coverage gap), and then 5% of your drug costs (or a small copay) for the rest of the calendar year after you have spent $3,600 out-of-pocket. Your plan pays the rest. In other plans, you may have tiered cost sharing, either flat copay or coinsurance, by type of drug (e.g., generic or brand) after the deductible and until you reach $2,250 in total drug costs. Because of this flexibility in benefit design, it is important to compare benefits across plans.
The national average monthly premium is $32.20 for 2006--this will vary by plan. This premium may be deducted from your Social Security check or paid to the plan itself.
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Medicare provides extra help to cover your prescription drug plan expenses if your annual gross household income is below $14,355 (or 19,245 if you are married and living with your spouse), and your resources are less than $11,500 if single and $23,000 if married. To apply for extra help, contact Social Security at 800-772-1213 or apply online at www.socialsecurity.gov.
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Yes, all annual medical out of pocket expenses are deductible for purposes of VA means test (subject to those aggregate expenses that exceed 5% of VA's applicable maximum pension rate).
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No, by law VA does not bill Medicare.
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No, VA health care and prescriptions benefits are separate and distinct from Medicare prescription drug plan requirements.
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VA is currently discussing strategies to provide proof of VA enrollment to CMS.
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A veteran who is or who becomes a patient or inmate in an institution of another government agency (for example, a state veterans home, a state mental institution, a jail, or a corrections facility), may not have creditable coverage from VA while in that institution. Veterans who are unsure whether this may apply to them should contact the institution where they reside, the VA Health Benefits Service Center at 1 877-222-VETS (8387), or their local VA medical facility.
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The veteran would be able to join a Medicare plan without penalty if he/she signs up within 62 days of loss of such enrollment status.
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Although VA is not enrolling any new veterans in priority category 8, VA has never used the enrollment process to cut-off or disenroll current enrollees. Depending on available funds, the cut-off point for enrollment may change in the future. If such an enrollment decision is made in the future, the veteran would be able to join a Medicare plan without penalty is he or she signs up within 62 days of losing enrollment.
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For this information, please call 800-733-8387or visit http://www.va.gov/hac/forbeneficiaries/
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Remember, the VA medical benefits program is separate from Medicare. Veterans may be enrolled in both programs but the enrollment process (and the eligibility criteria) is distinct for each.
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The Medicare program is divided by types of care or service: inpatient ("Medicare Part A"), outpatient ("Medicare Part B"), and prescription drug ("Medicare Part D"); seniors can decide in which "parts" of Medicare they wish to participate. VA offers a comprehensive medical benefits program that does not distinguish among the types of care or services received; generally veterans who are enrolled in VA health care are eligible for the entire medical benefits package (including prescription drugs), however, some veterans may be subject to a copayment for some care or medications received.
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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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Veterans could be subject to a penalty for enrolling "late" for Medicare Part B, even if they are enrolled in VA health care. This is different than Medicare Part D (prescription drugs) where veterans can delay enrollment without penalty if they are enrolled in a prescription drug plan that provides a benefit at least as good as that offered by Medicare. The prescription drug benefit in the VA medical benefits program is at least as good as that offered by Medicare. In addition, "late" enrollment in Medicare may only be allowed at certain times (like the beginning or end of the year) and individuals who choose not to enroll when they are first eligible may be left without access to health care until they can enroll in Medicare.
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Veterans should take time to understand their options under the Medicare program. They should read carefully all information received from Medicare or the Social Security Administration-action may be required. For example, seniors are required to sign and return a card if they choose NOT to enroll in Medicare Part B. Failure to return the card could result in automatic enrollment and deduction of the Medicare Part B premium from the beneficiary's Social Security check. Conversely, without some action, a senior would not be automatically enrolled in the prescription drug coverage under Medicare Part D.
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