How does signing up for Medicare work if you're also receiving benefits from the VA?

That is good info for ALL of us…

Let me start by saying I’m a medical biller/coder, so this is right up my alley along with those who can say been there done that.

Keep in mind that if you use your VA benefits, cost share is either $0.00 or a small co pay depending on where you go, but you already know that.

You’ll automatically be enrolled into Medicare Part A once you become eligible for Medicare. Medicare Part A only covers those services provided by a hospital such a surgery, in-patient stays, out-patient stays, etc. Medicare Part B will cover visits to a doctor’s office, but you need to sign up for that; you won’t be automatically enrolled. Medicare Part D is for prescription drug coverage, but you also need to sign up for that. If you’re getting your medicine from the VA, I wouldn’t bother with Part D coverage.

I don’t know all that much about Part A coverage because I work in a doctor’s office. Part B coverage I know.

Medicare Part B covers 80% of what Medicare allows a medical provider to collect per their contract with Medicare leaving the remaining 20% to you. For example, if you see a doctor as a new patient and Medicare allows that doctor to collect a total of $182.43 for your visit, Medicare will pay $115.52 leaving you responsible for the remaining $66.91. Medicare Part B also as a deductible of $185.00 (which changes from year to year), which you will have to pay before Medicare will start paying that 80%.

Some people get a supplemental insurance to cover the 20% Medicare will leave behind, but take care in the plan that you choose. Some plans will not pay until you meet the Medicare deductible. After that, some will pay 100%, but some won’t. Some have a deductible you have to meet with them before they will start paying. Some won’t even pay 100% of the 20% leaving you always owing something.

I’ve seen some mention that they have what’s call a Medicare advantage plan or Medicare replacement plan. That is, whatever insurance they have, it takes over for their Medicare insurance so Medicare can no longer be billed, but take care in the plan you choose. Some plans are HMOs that require you to have a primary care provider (non-VA). If you need to see a specialist, you will have to obtain a referral from your primary care provider first just like with the VA. Unlike the VA, it’s a much quicker and easier process. Some plans are PPOs that allow you to see any doctor of your choice whenever you want so long as that doctor is in-network. Generally speaking, HMOs are cheaper than PPOs both in co pays and premiums.

This is a “quick” and dirty on the subject. If you want more information, just message me and I’ll answer your questions as best I can.

I have both and use both the V.A. care and Medicare A. and B. The V.A. can function as a supplemental Ins. for medication etc. or part D. If you are away from a V.A. facility and need medical care, Medicare A & B will be necessary.

LTC. L. Bouchard