Compliance Bulletin
Veteran's Benefits and Medicare Advantage Plans
CB0005-18
March 1, 2018

Medicare eligible Veterans have options when it comes to healthcare. Veteran's Affair "("VA") plans and Medicare are completely separate. VA plans cover care received at VA facilities; Medicare coverage is received at facilities accepting Medicare assignment.

VA Coverage and a Medicare Advantage Plan ("MA") (with or without Part D) - Yes or No?

If a beneficiary is asking for your advice, here are the facts:

  • Individual must be enrolled in Medicare Parts A and B
  • Must live in the service area of a Medicare Advantage Plan
  • Cannot have End Stage Renal Disease (ESRD)

Medicare Advantage Plan Coverage - health care must be received through the Plan's Participating Provider ("PCP")

  • Many plans have $0 month premium (MA only or MAPD)
  • Healthcare may be closer to home and easier to access for an immediate need; e.g., cold, flu, stitches, broken bone, etc.
  • Coverage for an emergency or urgently needed care in and outside of the carrier's network

MA Plan with Part D

  • If the beneficiary sought medicare care through the plan's contracted provider, the prescription medicare will be filled through the MA carrier's contracted pharmacy provider.

*Note: VA will fill prescriptions prescribed by a non-VA provider only if all of the following criteria are met:

  • Individual is enrolled in VA health benefits
  • There is an assigned Primary Care Doctor
  • Individual has provided the VA health care provider with medical records from the non-VA provider
  • VA health care provider agrees with the medication prescribed by the non-VA provider

https://www.va.gov/HEALTHBENEFITS/access/prescriptions.asp

IMPORTANT INFORMATION

The VA Plan and the Medicare Advantage Plan - with or without Part D - are separate and distinct plans. Specifically, the VA is not primary and the MA Plan is secondary or vice versa. Both programs are federally funded and the government only pays once.

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