Many Iowans are eligible for both Medicare and Veterans’ health benefits. “However, there is often confusion about which program pays for a particular health service,” says Kris Gross from the state of Iowa’s Senior Health Insurance Information Program (SHIIP).
If you have or can get both Medicare and Veterans’ benefits, you can get treatment under either program. When you get health care, you must choose which benefits you are going to use. You must make this choice each time you see a doctor or get health care. Medicare can’t pay for the same service that was covered by Veterans’ benefits and your Veterans’ benefits can’t pay for the same service that was covered by Medicare. However, to get the Veteran’s Affairs (VA) to pay for services you must go to a VA facility or have the VA authorize services in a non-VA facility.
There may be situations when both the VA and Medicare can pay for different services within the same episode of health care. If the VA authorizes services in a non-VA hospital, but doesn’t pay for all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered part of the services that the VA doesn’t pay for.
For example, let’s say Jim is a veteran and goes to a non-VA hospital for a service that is authorized by the VA. While at the non-VA hospital, Jim gets other non-VA authorized services that the VA refuses to pay. Some of those services are Medicare-covered services. Medicare may pay for some of the non-VA authorized services that Jim got. Jim will have to pay for services not covered by Medicare or the VA.
When it comes to drug coverage the two benefits don’t work together. An individual can have both VA drug coverage and a Medicare Part D plan, but only one coverage will pay for a drug. When filling a prescription the individual will have to decide which to use--VA coverage or their Part D coverage, but they can’t use them both at the same time. The VA prescription drug benefit is credible coverage (i.e. it is as good as or better than Medicare’s drug coverage) so a veteran does not have to enroll in a Medicare Part D plan. Some veterans choose to have both in case the VA doesn’t cover a drug that Medicare Part D might. If a veteran wants a Part D plan they can enroll during any valid enrollment period. Medicare’s next Open Enrollment Period is October 15 through December 7 and new plan choices go into effect January 1.
Over 300 SHIIP counselors around the state are available to sit down with you face-to-face to explain Medicare and help with your questions about drug coverage and health insurance plans that supplement Medicare. To make an appointment with Pella area SHIIP counselors, call 641-628-1212; or to find the nearest SHIIP site to you, call 1-800-351-4664 (TTY 800-735-2942), go to www.therightcalliowa.gov or e-mail firstname.lastname@example.org. All services are free, confidential and objective.