Why can't I use my Medicare "Part D" to pay the copay for my VA prescribed medications?

2019-07-01T01:48:07-04:00

Every month I get a bill from the VA pharmacy, which I pay out-of-pocket. Meanwhile, I pay out-of-pocket for my Medicare benefits, including the Part D drug benefit, a payment that Medicare deducts from my social security payment. When I used a private doctor and filed a claim for Medicare to pay, Medicare rejected it, stating that the VA was my primary provider and I should have gone there for treatment, not to a "Doc in the Box." I am paying for a service that I cannot use.

Response by PO1 H Gene Lawrence made Jul 1 at 2019 1:53 AM

2019-07-01T01:53:29-04:00

Maybe a VSO could help.

Response by Capt Daniel Goodman made Jul 1 at 2019 2:37 AM

2019-07-01T02:37:31-04:00

http://www.vetadvicates.org

That is an interesting point, one would logically think that VA benefits ought to be combinable with Medicare and/or Medicaid, certainly...I mean, God knows, no one ever listens to me, I'm just an insignificant little peon nothing nobody, however, to my mind, you do make an interesting, and, seemingly, quite logical point, as I'd said...some meds fall under Medicare Parts B or D, in our case, plus, we just got that new CHAMPVA OptumRx card for my wife, as wwll, so what you'd asked was, certainly quite thought provoking...the group I sent in the site for here, NOVA, is quite well hooked into a good deal, I'm not saying their guys could definitely answer this, however, I merely suggest it as a possible avenue to call, possibly their office directly, or use their search engine to find their guys by you...there are also law school vet law clinics you could seek out, though they done take eveeybidy, that's up to law school faculty supervising law students researching cases...another thought, you could call VA Off of Resolution Mgmt (ORM), and see if they have any ideas, also, try calling VBA and/or VHA directly...I'd also most definitely ask all three local ofc mil/cover staffs for all three of your Congress more as well, if the question involved Medicaid, ever, I'd also ask state legislators, as well as off staffs of governors, though I realize your question is a purely Federal one here, not a state one, per se...as I'd said, you do raise a quite interesting point, I'll try to give it more thought, if you've got any further thohghts, I'd be most eager to hear them, no rush...and, as mentioned below here, you could also certainly try the major vet groups...you could also call CMS directly, that supervises Medicare, and get their ombudsmen staff on the ohone, they do pick up, we've spoken with CMS staff many times, I assure you, or ask your Congress ofcs to get you a call back, as well, OK?

www.vetadvicates.org

Response by SSG Dalia Cox made Jul 1 at 2019 6:40 AM

2019-07-01T06:40:05-04:00

Just to get more info. Are you recieving SSD(Social Security Disabilty)?

Response by Patricia Overmeyer made Jul 1 at 2019 11:35 AM

2019-07-01T11:35:34-04:00

Pvt Anthony Baxter: The reason that Medicare and the VA will not pick up each other's tabs is that one federal agency cannot pay for another federal agency's bills. What issue you may be having will depend on what your "rating level" (not your disability rating) is within the VA. If the reason you went to the private doctor is because of a condition not covered by the VA, then Medicare should pick up the tab. If the VA does cover that condition, then you are to go through the VA. You may or may not be eligible for the VA Choice program but you should certainly look into that. Here's the VA link regarding the coverage. You may want to talk with an AARP representative who can give you further information regarding which coverage you will want to choose. My husband and I talked with an AARP representative who was able to help us navigate between the two systems.
https://www.va.gov/health-care/about-va-health-benefits/va-health-care-and-other-insurance/

VA health care and other insurance | Veterans Affairs

Find out how you can use VA health care along with other health insurance (like a private insurance plan, Medicare, Medicaid, or TRICARE). Get answers to questions about how VA health care works for Veterans with other insurance.

Response by Pvt Anthony Baxter made Aug 7 at 2019 12:55 PM

2019-08-07T12:55:58-04:00

The VA Administration has implemented some policy changes that are somewhat relevant to my question about using Medicare to pay VA co-pay payments. The VA now allows Veterans in need of immediate care to go to nearby "Doc-in-the-Box" (i.e., urgent care) facilities in our communities instead of trekking miles (40+ in my case) to a VAMC emergency room and waiting hours for treatment. The VA's pharmacies will honor prescriptions written by licensed Urgent Care practitioners, and as well, I am informed that Veterans also can fill these prescriptions at supermarket pharmacies like Wal-Mart and Ralph's.

Although these changes do not resolve my issue, because I still must pay "out-of-pocket" co-pay costs, they show that the VA Administration is trying to be more responsive Veterans' immediate needs. Meanwhile, I appreciate the advice and guidance of my Rally Point brothers and sisters.