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The Benefits of Part D Coverage for America’s Veterans

This week, we celebrate Veteran’s Day, a time of thanks and appreciation for the sacrifices and service given to all of us by the men and women who are or have been in our armed forces. Providing the highest quality healthcare to our veterans is a national priority, so we wanted to review some important considerations for veterans who are eligible for Medicare.

There is a common but mistaken assumption that all veterans and their families receive health care services through The Department of Veterans Affairs (VA) or The Department of Defense. In fact, though millions of veterans use the VA system, not all veterans receive care that way. Moreover, except in very limited circumstances, spouses of veterans are not eligible to receive care through the VA system at all. Actually, millions of veterans are enrolled both in Medicare and in the VA Health system and thus receive different but very essential health benefits from each one.

VA encourages veterans who are eligible for Medicare to opt to enroll in Medicare Parts A and B so that they have coverage for medical services received outside the VA system. That is because VA only pays for services provided at a VA facility or a pre-approved non-VA provider. It’s easy then to see then why Medicare coverage may be particularly important, for example, if a beneficiary doesn’t live near a VA facility.

Another fact to keep in mind is that by enrolling in Medicare Part B when a veteran is first eligible, there is protection should VA benefits ever be lost or if any gaps in coverage occur. (More specifics on this are available at www.medicare.gov and www.va.gov.)

Medicare Part D is optional as well, but many veterans choose to supplement their VA coverage with a Medicare Part D plan.  Here are some reasons why:

  1. VA will not fill prescriptions written by providers outside the VA system. If a veteran enrolled in the VA Health System also takes medicine prescribed by a private clinician, Part D provides coverage for the medicine but VA will not. This situation can also arise if a veteran enters a non-VA nursing home or care facility and needs to use their pharmacy; VA will not cover this but Part D will.
  2. Only the veteran (except for CHAMPVA beneficiaries) can use the VA Health system pharmacy, so spouses definitely need to have coverage through Part D or another creditable plan. Creditable coverage means that the plan has been evaluated and found to provide coverage equal to or better than the basic Part D benefit plan.
  3. VA coverage only applies to VA pharmacies and mail order services. If a veteran lives far from a VA facility and needs new medicines suddenly and/or quickly, a local pharmacy would be an important option. Medicare Part D would cover the medicines but VA would not.
  4. Finally, for low income persons, Medicare provides financial help for Medicare Part D beneficiaries through its low-income subsidy (LIS) program. Some veterans who are eligible for this program may find that enrollment in Part D will reduce their drug costs even more.

If you have questions about VA benefits and coverage, contact the VA Health Administration Center at 1-877-222-8387.  If you have questions about Medicare, contact them at 1-800- 633-4227.