Important educational information regarding veterans and their Medicare benefits. Many veterans do not know some of this important information shown in this presentation.

1. Veterans, Medicare and
Medicare Insurance

2. CALIFORNIA VETERANS
23 million veterans of the United States armed
forces may be eligible for a broad range of programs and
services provided by the U.S. Department of Veterans
Affairs (VA)
The largest number, nearly 2,200,000 veterans, live in
California.
VA Expenditures in CA: $9 Billion
Department of Veteran Affairs

3. VA Health Care
U.S. Department of
Veterans Affairs

4. How VA Health Care Works
VA determines eligibility for the comprehensive medical benefits
package through a patient enrollment system.
The system is based on Priority Groups 1 through 8.
Eligibility for VA benefits is based on each Veteran’s unique eligibility
factors.
Veterans must apply to obtain access to VA health care benefits.
Once the application is successfully processed, the VA will notify the
Veteran of the priority group assignment, the benefits the Veteran is
eligible for and information about how to access the VA health care.
If not accepted the Veteran can appeal the decision.
Veteran’s Health Guide: Department of Veteran’s Affairs

5. Tricare and Tricare For Life

6. TRICARE and TRICARE For Life Overview
Active Duty
TRICARE
Retired from
Service
TRICARE
When age 65 and
have Parts A & B
enrolled in TFL

7. TRICARE, TRICARE For Life and Medicare Services
For Services
covered by
both Medicare
and TRICARE
Medicare pays
first
TFL pays the
remaining co-
insurance of TFL
covered services
For services
covered by
TRICARE but
not Medicare
TFL pays first
and Medicare
pays nothing
You must pay
the TFL
deductible and
cost shares
For services
covered by
Medicare but
not TRICARE
Medicare pays
first and TFL
pays nothing
You must pay
the Medicare
deductible and
coinsurance

8. TRICARE, TRICARE For Life and Medicare Services
For services not
covered by
Medicare or TFL
Medicare
and TFL
pay
nothing
You must
pay the
entire
bill

9. Affordable Care Act (Obamacare) and VA
Health Administration
The provisions of the Affordable Care Act (ACA) upheld by
the U.S. Supreme Court will not affect the current role
the Department of Veteran’s Affairs (VA) has in the lives of
America’s Veterans. We will continue to provide Veterans
with high quality comprehensive health care and benefits
they have earned through their service. VA health care
does not change as a result of the ACA.
--- United States Department of Veterans Affairs

10. What Do Veterans Think Of VA Health Care?
One point of view: Time Magazine
Report: ―You can expect VA’s highly qualified and
dedicated health care professionals to meet your needs,
regardless of the treatment program, regardless of the
location.‖
Article: ―How Veterans' Hospitals Became the Best in
Health Care‖ (http://www.time.com/time/magazine/article/0,9171,1376238,00.html#ixzz2KTaM9GIx From
TIME Magazine, 2006)

11. What Do Veterans Think Of VA Health Care?
Other Headlines:
―Veterans Wait for Benefits as Claims Pile Up‖ (From The
New York Times, Sept. 2012. Taking up to two years to process.)
“Hundreds of thousands of war vets still waiting for
health benefits” (From Phoenix CNN Health, October 2012)
―VA works to resolve problems after doctors, veterans
complain about sluggish reimbursements for care‖ (By
Rhiannon Meyers, Posted March 18, 2012 at 6:40 a.m., updated March 18, 2012 at 10:36
a.m.)

12. What Do Veterans Think?
Corpus Christi, Texas
 CORPUS CHRISTI — Disabled veteran Roy Stamper, 54, spends
his days in front of a television, hobbling around his
apartment on a cane and managing the constant sharp pain
and numbness in his artificial hips with daily morphine pills.
 For months, Stamper tried to find a local orthopedic surgeon
to take a look at his hips and diagnose the pain, but over and
over again, he found that doctors simply refused to accept a
voucher that promised reimbursement for care from the U.S.
Department of Veterans Affairs.
 Some local doctors have stopped seeing veterans because the
VA has taken too long to reimburse them for the treatment.

13. Our Country’s Health Insurance Program

14. What is Medicare?
Medicare is our country’s health insurance program
for people age 65 or older. Certain people younger
than age 65 can qualify for Medicare, too, including
those who have disabilities, permanent kidney failure
or amyotrophic lateral sclerosis (Lou Gehrig’s
disease). The program helps with the cost of health
care, but it does not cover all medical expenses or
the cost of most long-term care.
--- Social Security Administration

15. Medicare At A Glance
Original
Medicare
Part A
Hospital
Part B
Doctors
Medicare
Insurance from
private companies
Part C plus benefits
Part D Prescription Drugs

16. Disability Planner:
Medicare Coverage If You Are Disabled
To qualify for Social Security disability benefits, you must
first have worked in jobs covered by Social Security. Then
you must have a medical condition that meets Social
Security's definition of disability. In general, Social
Security pays monthly cash benefits to people who are
unable to work for a year or more because of a disability.
The Social Security Administration automatically enrolls
you in Medicare after you get disability benefits for two
years. The two parts of Medicare they enroll you in are
hospital insurance (Part A) and medical insurance (Part B).
---Social Security Administration

17. Key Question That Veteran’s
Should Ask About Medicare
If I have good medical coverage from the Veterans Affairs health
program, do I need to enroll in Medicare Part A and Part B when
I turn 65 and enroll in Part C and Part D?
Answer: (AARP Bulletin, May 2012)
You don’t have to enroll in Medicare, but there are 5 good
reasons why you should definitely enroll in Parts A and B and
look into enrolling in a Part C Advantage Plan that includes Part
D and other benefits. In fact, the VA strongly recommends that
all veterans who have VA health care also enroll in Medicare as
soon as they become eligible (unless they have other coverage –
for example, from an employer or union.

18. Reasons #1and #2
1. VA health coverage is not set in stone and is not the same
for everyone.
The VA assigns enrollees to different priority levels according to various
factors. If federal funding drops, or doesn’t keep pace with costs some
veterans in the lower priority levels could lose VA coverage entirely.
2. Having both Medicare (Parts A, B, C and D) and VA benefits
widens your coverage.
If you need to go to a non-VA hospital or doctor, you are automatically
covered under Medicare Part A (hospitalization) and Part B (doctors and
outpatient services) –whereas with A coverage alone, you may end up
having to pay the full cost yourself. The Part C Advantage Plan would cover
the out-of-pocket costs. The VA has rules about who qualifies for coverage
at non-VA facilities, even in emergencies.
-- AARP Bulletin, May 1, 2012

19. Reason #3
3. Part B late penalty.
If in the future, after you are well past 65, you happen to lose
VA coverage, or you decide that you need Medicare and are not
already signed up for Part B, you would pay a late penalty to
enroll at that time. The penalty permanently adds an extra 10%
to your monthly premium for each year that you delay. If you
wait 5 years to sign up for Part B and have had no other health
insurance apart from VA’s, you would pay 50% more for the same
coverage for the rest of your life.
-- AARP Bulletin, May 1, 2012

20. Reason #4
4. Prescription drug coverage Part D benefits.
Your prescription drug coverage in the VA is much better than
Medicare’s, so you don’t need to join a Part D drug plan, and you won’t
incur a Part D late-enrollment penalty if you lose your VA coverage in
the future. Still, if you decide to have Part D (which is part of the
Advantage Plan, Part C or purchased by itself) you would have the
flexibility of being able to use one or the other. You could get
prescriptions from non-VA doctors and fill them at local retail
pharmacies instead of going to a VA doctor for a prescription and having
it filled through the VA mail order service and may be able to obtain
medications that the VA doesn’t cover.
-- AARP Bulletin, May 1, 2012

21. Reason #5
5. Enrolling in Medicare Part A and Part B qualifies you to
enroll in Part C Advantage Plan which includes Part D
prescription drug coverage and other benefits.
Part C Advantage Plans in many areas are offered at a $0 (zero)
premium fee. For no additional out-of-pocket monthly costs, veterans
can have health coverage from two different sources. Veterans can
choose which local or VA hospitals and/or doctors to visit that will best
fit their medical needs. This is an advantage that no other group of
citizens enjoy. Veterans are encouraged to examine the Part C benefits
to determine if these will a plus for their rising health costs.
-- AARP Bulletin, May 1, 2012

22. Which Veterans Should Examine the Part C
Advantage Plan Possibilities?
Veterans who will turn 65 this year.
Veterans who are 65 and older who have VA health
coverage and are still working for an employer or union
and have additional coverage and will be retiring soon.
Veterans who are younger than 65 and are on disability.
Veterans who have TRICARE For Life and Medicare but
have a medical need that is not covered by TFL.

23. Thank You