A veteran’s guide to Medicare, TRICARE For Life and VA benefits

Understanding your benefits

If you’re a military retiree approaching the age of eligibility for Medicare, you may have questions about how your VA benefits, Medicare and programs like TRICARE® For Life and Department of Veterans Affairs, or VA, health benefits, or CHAMPVA, fit together.

It can be complicated, but it doesn’t have to be overwhelming. Having a basic understanding of these programs can help you make sure you have the coverage you need from the benefits you qualify for so you can save money.

Signing up for Medicare

Signing up for Medicare can feel intimidating, and you might be worried about missing important paperwork or annual enrollment periods.

• If you're fully retired, enroll in Original Medicare, or Medicare Parts A and B, during your initial enrollment period, or IEP.
• If you are still working and covered by an employer health insurance plan, you can delay signing up for Part B but can sign up for Part A.
• Part A is free if you worked and paid Medicare taxes for at least 10 years.
• If you're already receiving Social Security benefits at age 65, Part A and B are automatic.
• If you don’t sign up for Part B during your IEP, you could be subject to a penalty when you do enroll later, unless you have what is considered creditable coverage, such as a qualified employer plan.

Those are just the basics on Medicare enrollment, but knowing those key pieces can help you navigate your VA benefits and understand how all the parts come together.

Medicare and VA Benefits

First, let’s tackle how Medicare and your VA benefits work together. This can apply to veterans who use VA facilities, not just military retirees.

Why is Medicare important if I have VA coverage?

Emergencies happen. If you need care outside a VA hospital or clinic, being enrolled in Medicare helps ensure you’re covered in the event you’re not near a VA facility or don’t have easy and quick access to care. In addition, VA coverage for care received outside the VA system may depend on factors such as whether the care is authorized by VA and the circumstances of the treatment. If the VA does not cover the care, you could be responsible for out-of-pocket costs.

What’s important to know

• There is no coordination of benefits between the VA and Medicare.
• Medicare and VA benefits don’t replace each other, they complement one another. This means that even if you have VA benefits, it’s recommended that you still enroll in Medicare Part A and B when you are eligible.
• VA benefits cover care at VA facilities with a few exceptions, such as emergencies or VA Community Care.
• Medicare covers care outside the VA system, like civilian hospitals and doctors.
• The VA is considered creditable coverage for prescription drugs. You would not be required to enroll in a separate Medicare Part D prescription drug plan. However, you’ll want to ensure the VA covers your medications, and if not, a Part D plan could still make sense.

What is TRICARE For Life?

Learn the benefits of TRICARE For Life, or TFL, and how it works with Medicare for your health care as a veteran.

TFL is similar to a Medicare Supplement policy, also known as Medigap, though it is not technically a Medigap plan. TFL serves as Medicare-wraparound coverage for eligible military retirees and their families, with no separate enrollment fee or premium. To be eligible for TFL, you must be enrolled in Medicare Parts A and B and have your eligibility information updated in the Defense Enrollment Eligibility Reporting System (DEERS). There is no separate enrollment process for TFL.

TFL and Medicare

In most cases, Medicare provides primary coverage, meaning it pays first, and TFL helps cover many of the remaining out-of-pocket costs for services covered by both programs.

And since TFL also includes prescription drug coverage, you don’t need a Medicare Part D plan. However, as with most plans, your costs will vary based on your drug category, with “generic formulary drugs” typically being less expensive than brand-name medications. Just like when you were under an employer-provided plan or TRICARE, it’s important to take care to ensure you get the care you need at the most affordable cost.

But one important thing to note is that neither TFL nor Original Medicare include coverage for routine dental and vision benefits. So, that leads to an important question: Are TFL and Medicare enough?

Are TRICARE For Life and Medicare enough?

Whether TRICARE For Life and Medicare are enough for you and your family depends on your needs. Some people are willing to take the financial risk of going without dental and vision coverage. But many people will benefit from some type of dental and vision coverage, which can come through a Medicare Advantage, or Part C, plan.

These Medicare Advantage plans may or may not have a monthly premium, but may have more out-of-pocket costs at the time of care.

Speak with a licensed health insurance agent to review whether a Medicare Advantage plan and TFL are right for you and to better understand how the coverage works together. For example, if you enroll in a Medicare Advantage plan, the Medicare Advantage plan will generally pay first, and TFL may help cover remaining costs for services covered by TRICARE.

A Medicare Advantage plan may require you to use providers within its network to receive the highest level of coverage. This means your choice of doctors and hospitals may be more limited than it would be with Original Medicare. If you have both a Medicare Advantage plan and TFL, it's important to understand how the two types of coverage work together and whether your providers participate in your plan's network before receiving care.

If you’re thinking about dental and vision coverage, military retirees may have options through the Federal Employees Dental and Vision Insurance Program, or FEDVIP.‍ ‍ Depending on your eligibility, FEDVIP offers a variety of dental and vision plans, making it important to compare your coverage needs, provider networks, and costs before choosing a plan. Knowing your options is the first step.

Additionally, you may be able to purchase dental and vision coverage from private insurance carriers if you don't find a FEDVIP plan that meets your needs.

Veterans traveling and living overseas

Traveling and living overseas can be a great way to spend all or part of retirement. That is, until you need medical care. So, how does your medical coverage provide for you while you are outside the U.S.?

What are my health care options if I’m eligible for Medicare?

Medicare is primarily limited to care in the U.S. and its territories. The Medicare website lists three situations when Medicare “may” pay for certain types of health care you receive in a foreign hospital:

1. You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat you.
2. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat you. Medicare determines on a case-by-case basis what situation qualifies as “without unreasonable delay.”
3. You live in the U.S., and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat you, regardless of whether you have a medical emergency.

If you're traveling overseas, a travel medical insurance policy may be worth considering since Medicare generally does not cover most health care received outside the U.S. and its territories.

If you're traveling or living overseas and have TFL, your coverage generally continues worldwide. In most overseas locations, Medicare does not provide coverage, so TFL becomes the primary payer for TRICARE-covered services, and standard TRICARE deductibles, cost shares, and coverage rules apply.‍ ‍

If you're living abroad and become eligible for Medicare, contact the Social Security Administration for information about Medicare enrollment and maintaining your coverage.

Civilian Health and Medical Program of the Department of Veterans Affairs, or CHAMPVA

CHAMPVA is a health care benefit available to a smaller group of eligible veterans' family members and survivors. To qualify for CHAMPVA, you generally cannot be eligible for TRICARE and must meet at least one of the program's eligibility requirements.‍ ‍

Here are a few important things to understand about CHAMPVA:‍ ‍

• CHAMPVA has no monthly premium and includes cost-sharing, a deductible, and a maximum annual out-of-pocket limit.
• In many cases, CHAMPVA will act as secondary coverage, meaning your other health insurance pays first.
• If your eligible for Medicare, you generally must have and maintain Medicare Parts A and B to get and keep CHAMPVA benefits, subject to certain exceptions.
• If you are enrolled in CHAMPVA, you may be eligible to purchase dental coverage through the VA Dental Insurance Program, or VADIP.

If you’re eligible, CHAMPVA can be a valuable benefit. But be sure to compare its costs and coverage with other health insurance options available to you.

Ready to make the most of your benefits?

If you’re a veteran approaching Medicare eligibility, here are your next steps to consider, depending on your situation.

Situation #1: I will be eligible for TFL, with or without VA coverage.

• Ensure you enroll in Original Medicare, Parts A & B, a requirement for TFL eligibility.
• You don’t need a Medicare Supplement plan or Medicare Part D prescription drug plan.
• Consider whether you need additional dental or vision coverage, which could include enrolling in a standalone vision or dental plans, or a Medicare Advantage plan.

Situation #2: I’m a veteran without TFL, but I have VA coverage.

• It is recommended you enroll in Original Medicare, Parts A and B.
• Consider enrolling in Part D if you want access to drug coverage outside the VA.
• Determine whether your healthcare needs and expected costs might be better addressed through a Medicare Supplement plan or a Medicare Advantage plan. Some Medicare Advantage plans offer benefits that may be particularly attractive to veterans.

Situation #3: I’m a veteran eligible for CHAMPVA and Medicare.

• Ensure you enroll in Original Medicare, Parts A and B, a requirement for CHAMPVA eligibility.
• Many CHAMPVA beneficiaries find they do not need a Medicare Supplement policy or a separate prescription drug plan, though individual needs may vary.
• Consider whether additional dental or vision coverage would be beneficial. You may also wish to evaluate a Medicare Advantage plan or explore VADIP.
• For those who enroll in enroll in a Medicare Advantage plan and have CHAMPVA, Medicare Advantage becomes the primary payor.