Medicare Outpatient Prescription Drug Coverage
Veterans need to know how the new Medicare prescription drug coverage (also known as Medicare Part D) may affect them and their VA healthcare prescription benefits
- Starting January 1, 2006, Medicare prescription drug coverage (Medicare Part D) becomes available to everyone with Medicare Part A or B coverage.
- The Centers for Medicare & Medicaid Services is implementing this new program.
- You can sign up for Medicare’s new prescription drug coverage starting November 15, 2005 through May 15, 2006.
- The Medicare prescription drug coverage is wholly voluntary on the part of the participant.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added a new prescription drug program to Medicare.
The Medicare prescription drug coverage is available to everyone with Medicare Part A or B coverage. Medicare prescription drug plans provide insurance coverage for prescription drugs. These plans will be offered by insurance companies and other private companies. Plans will cover both generic and brand-name prescription drugs.
There are two types of Medicare prescription drug plans:
- There will be prescription drug plans that add coverage to the Original Medicare Plan.
- There will also be prescription drug coverage that is part of Medicare Health Plans (Medicare Advantage and Medicare Cost Plans).
Most entities that currently provide prescription drug coverage to Medicare beneficiaries (such as insurance companies or former employers) must disclose whether the entity’s coverage is “creditable prescription drug coverage.”
VA has determined that the prescription drug benefit provided as part of the medical benefits package for those veterans enrolled in the VA health care system, on average for all enrollees, is expected to provide a benefit that meets or exceeds what the standard Medicare prescription drug coverage will pay (“creditable coverage”). This means that enrollment in the VA health care system provides a prescription drug benefit that is at least as good as the Medicare drug coverage. It also means that enrolled veterans may choose to wait and join a Medicare prescription drug plan after May 15, 2006 without having to pay a higher monthly premium (“late enrollment penalty”).
No, veterans enrolled in the VA health care program may choose not to enroll in a Medicare prescription drug plan, if they feel the VA program meets their needs. If veterans wish to enroll in a Medicare prescription drug plan at a later date, they will not be subject to the late enrollment penalty.
No, a veteran may choose to have both VA prescription coverage and Medicare prescription drug coverage. Please note that VA health care enrollment (which includes prescription coverage) and the Medicare prescription drug coverage are separate and distinct programs.
Yes, you may have both, but you won’t be able to have a single prescription covered by both programs. If you want to have both VA and Medicare, you can choose on a prescription by prescription basis whether to get it written and filled under either VA or Medicare, but the prescription can not be covered by both plans at once. If a prescription is filled by a Medicare drug plan, Medicare copays will apply, VA will not be billed for the prescription. If a prescription is written and filled by VA, VA copays will apply, and Medicare will not make a payment.
For veterans considering enrollment in a Medicare prescription drug plan, there are several factors to consider such as access and cost:
Unlike Medicare, which offers the same benefits for all enrollees, VA priority levels may change and veterans may not always have access to VA health care. Veterans may benefit from Medicare drug coverage if they reside in or move into a nursing home or live in a geographical area that may limit their ability to access their VA prescription benefits.
VA prescriptions, with limited exceptions, must be written by a VA practitioner and filled through a VA pharmacy either in person or by mail through VA’s Consolidated Mail Outpatient Pharmacy Program (CMOP).
The veteran may consider the flexibility offered by a Medicare prescription drug plan to get prescriptions filled from their local retail pharmacies. Medicare requires that prescription drug plans contract with pharmacies in your area.
If veterans want to wait and join a Medicare prescription drug plan after May 15, 2006, and are enrolled in the VA healthcare system, they won’t have to pay a higher monthly premium for joining a Medicare drug plan later.
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. If you think this applies to you, please contact the institution where you reside, the VA Health Benefits Service Center at 877-222-VETS (8387), or your local VA medical facility.
Read the “Medicare & You 2006” handbook you should have received in the mail in October 2005. It includes detailed information about Medicare prescription drug plans, including which plans will be available in your area. After that time, if you need help choosing a Medicare prescription drug plan that meets your needs, you can do the following:
- Visit www.medicare.gov on the web and select “search tools” to get personalized information.
- Call your State Health Insurance Assistance Program (see your copy of the “Medicare & You 2006” handbook for their telephone number). You can also call 800-MEDICARE (800-633-4227), or visit www.medicare.gov on the web to get the telephone number. TTY users should call 877-486-2048.
- Call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048.
Comparison Table of Medicare Part D, VA, and CHAMPVA Coverage of Outpatient Drugs
Questions and Answers about Medicare Part D and VA Prescription Drug Benefits
Federal Benefits for Veterans and Dependents
VA National Means Test Income Threshold |
GMT Income Threshold
Viewers, Plug-Ins, & Readers |
VA Health Care Eligibility & Enrollment Site Map
For questions about Health Care Eligibility, please visit the VA inquiry website.
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