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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.



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Things to Consider When Choosing Your Medicare Plan This Open Enrollment

Open Enrollment is here again. We have the opportunity to review our Medicare Part D coverage to make sure it is right for us. From time to time, I have heard people complain that this yearly process is annoying and unnecessary, but I beg to differ. In the course of a year, many things can change – from where we live to the medicines we take. The open enrollment period is an opportunity to ensure we have a plan that best meets our current needs.

 

Plans themselves can also change from year to year. For example, this year, my plan will no longer have a preferred relationship with my pharmacy. If I stay with my current plan and keep the same pharmacy, my medicines may cost more, and I will be taking that into account as I make my decision about what plan will give me the most value.

 

Other possible plan changes may have an even bigger impact on your purse. Be sure to compare the list of medicines you take with the list of medicines your plan will cover because the list may be different than last year. Also, double-check that all or at least most of your medicines are listed. Don’t just pick a plan because the premium is low. If the medicines you need aren’t covered, you could end up paying more.

 

You should also consider the amount your plan will pay toward the cost of your medicines. Most of us are familiar with co-payments – the fixed amount you pay when you visit a doctor, get a health service or, in this case, pick up your medicines – but beware, some plans have co-insurance rather than co-payments for some medicines. Co-insurance requires that you pay a percentage of the cost of a particular medicine rather than a fixed amount like the co-payment. From year to year, plans may change their formulary (the list of drugs they cover) and cost-sharing levels so that a drug which last year only required a co-payment may now require co-insurance. Because this will change the amount of money you will need to pay, it is really important to review your plan to see what coverage is provided.

 

When Medicare Part D was created, many patient groups and consumer advocates worked hard with CMS (the agency that runs Medicare) to make sure that Medicare beneficiaries would be able to get the medicines they need. The Open Enrollment process is one of the most important safeguards of this program because it guarantees that every year we can decide which plan works best for us.

 

So, PLEASE review your plan and make an informed decision during Open Enrollment. Visit the Medicare website (www.medicare.gov) and use the plan comparison tool to see what options you have or go to the Medicare
SHIIP Counselor at your local Area Agency On Aging. You can also call Medicare all day, any day except Federal holidays at 1-800-633-4227.

 

Tell us what you found when you reviewed your plan. Did you decide to make a change? Did you get advice from anyone? What advice do you have for others reviewing their plans?

 

Remember– Open Enrollment ends December 7.



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Helping Seniors Speak Out on Medicare Part D

Hello!  My name is Nona Bear and for the last 20+ years I have read about, talked about, studied, and listened to information and ideas about Medicare. One year ago, my “book learning” got upgraded to “hands on” experience, as I became a Medicare beneficiary myself.

My goal in writing this blog is to share my thoughts as both a person on Medicare, as well as, someone who works in health care advocacy. I hope that many of you will reciprocate by sharing your observations, ideas, recommendations and even critiques about how Medicare works for you.

As I write this, I have just come back from getting my prescriptions refilled at the pharmacy. I have great confidence in the pharmacists who are on staff and want to be able to keep getting my medicines from there. When I first chose a Medicare Part D plan, I took the time to review each plan’s list of participating pharmacies so that I could shop where I preferred. That choice was one of several important factors I considered when I selected a plan.

Now, with Medicare Open Enrollment around the corner, I will continue to take full advantage of the options that Medicare Part D provides.  In addition to keeping the pharmacy I want, I will be reviewing plans — including the one I have now — to be sure I get the best deal in terms of premium cost and, most importantly, coverage for the medicines I take. Having a choice means I have power as a consumer and as a patient, which is something I value and want to keep.

How will you take advantage of the options provided by Open Enrollment when it begins on October 15, 2014?  What factors are most important to you?  Where do you get the information you need to make your decision?  Where do you go for help in making your choice?

Please share your experiences and best advice on making the most of Open Enrollment or other things about Medicare that are on your mind. Be sure to check back with us regularly to read your thoughts and hear what other Medicare beneficiaries from around the country are saying.

I hope to hear from you soon!!