For Veterans, What is Creditable Coverage for Medicare?

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There are often misperceptions among the 9.4 million American veterans 65 and older about how benefits offered through the U.S. Department of Veteran Affairs (VA) work with Part B (physician and other outpatient medical benefits) and Part D of Medicare (prescription drug coverage).[1]

Questions about Medical Coverage

Many veterans with VA coverage don’t realize that they should sign up for Part B of Medicare when they first become eligible. If they do not, they may be subject to a financial penalty for as long as they have Part B coverage. Therefore, it is important for Veterans to understand their particular situation before declining Part B.

Guidance can be found in greater detail on Medicare.gov for veterans who currently have health benefits but are gauging whether to sign up for Part B. Things to consider vary based on the situation of each veteran, such as:

  • Having employer or union coverage. If veterans or their spouses are still working and have medical benefits through that employer or union, they should contact their benefits administrator.
  • Having TRICARE or CHAMPVA coverage. If retired service members have Part A of Medicare, they must have Part B of Medicare to continue their coverage through TRICARE or the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
  • Being an active-duty service member. Veterans don’t have to have Part B to keep their TRICARE while on active duty. Before they retire, active-duty service members who have Medicare because they are 65 or disabled generally must enroll in Part B using a Special Enrollment Period (SEP) to keep TRICARE without a break in coverage.
  • Having Veterans’ benefits. Enrolling in Medicare may provide veterans with additional service and location options. If they don’t enroll in Part B when first eligible, they may have to wait to sign up later, which could result in a costly late enrollment penalty.

Prescription Drug Coverage: A Few Options To Consider

For Veterans, weighing VA prescription drug benefits and a Medicare prescription drug plan is not an either/or proposition. The good news is that veterans can consider either or both options for coverage. Please note, however, you can’t use both types of coverage for the same prescription at the same time.

Veterans can receive Part D drug coverage by purchasing a standalone drug plan or by being enrolled in a Medicare Advantage plan that includes drug coverage. Veterans with prescription coverage through the VA may also wish to enroll in a Medicare Advantage plan that does not include prescription coverage. This affords them access to the additional medical benefits and programs offered by the Medicare Advantage plan while allowing them to use their VA prescription coverage with no conflicts.

Enrollment in the VA health care system provides a prescription drug benefit that has been determined to be as good as the benefit provided under a Medicare prescription drug plan. As a result, VA enrollment provides “creditable prescription drug coverage” for Medicare Part D purposes.

Humana is a Medicare Advantage HMO, PPO, and PFFS organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.

Dixon Keller

Regional Director Humana Inc.

Vietnam Veteran, US Navy

  1. U.S. Census Bureau: https://www.census.gov/newsroom/facts-for-features/2015/cb15-ff23.html