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Supplemental Health Insurance For Veterans

Medicare Supplemental Health Insurance for Veterans

Original Medicare & Medicare Supplements for Veterans

Since VA plans only cover treatment at VA facilities, the VA highly recommends you get Traditional Medicare coverage.

Congress sets the priority groups and funding for VA benefits each year. Those that are eligible for VA benefits are given a priority level numbered 1-8.

Your assigned priority level is what determines the level of benefits you’re eligible for, with priority number 1 getting the most amount of coverage and priority number 8 getting the least amount of coverage.

The VA recommends that all veterans, with any priority level, should supplement their VA benefits with Medicare.

However, those with higher priority levels will benefit the most. Your priority level is determined by factors such as the length of your military service and your income level.

There’s no guarantee that congress will approve enough funds for the VA to provide health care coverage to all priority levels, leaving you vulnerable and without any health care coverage.

That’s why Medicare is a great backup to keep your finances safe.

Should I Apply for Medicare Part A Hospital Coverage if I Have VA Benefits?

Should I Apply for Medicare Part B Medical Coverage if I Have VA Benefits?

Should I Apply for Medicare Part D Prescription Drug Coverage if I Have VA Benefits?

Possibly. Since veterans usually have prescription drug coverage from the VA, they normally choose to not enroll in Medicare Part D. Since VA prescription drug coverage is considered creditable coverage, you can enroll in Medicare Part D penalty free outside your initial enrollment period if you wish to have additional coverage with your VA drug coverage.

It’s important to note that your VA prescription drug coverage benefits will only cover prescription medications that were prescribed by a VA doctor.

Since Part D Medicare plans are considered affordable, a lot of veterans opt to enroll in this additional stand alone drug policy so that their medications are covered in the case they see a Medicare approved doctor.

Should I Apply for Medigap If I Have VA Benefits?

Most definitely! Medigap plans for veterans, commonly referred to as Medicare Supplements, will fill in the gaps in health care coverage left by your VA benefits and Original Medicare. All veterans are well aware of the reputation that VA facilities have received over the past few years.

Health care at a VA facility is prioritized by who is the most ill and who has the lowest income. They’re known for having a very long waiting period for important treatments and procedures.

Veterans who opt to enroll in Medigap will be able to see a provider sooner and have their out of pocket costs left after Medicare pays their portion covered. Such out of pocket costs that Medicare Supplements will cover include coinsurance, copayments and deductibles.

Medigap also includes coverage for veterans when traveling outside of the united states. With veterans having a real concern regarding their finances when it comes to health care during an emergency situation, more and more decide to enroll in Medigap.

When Should I Use Medigap Benefits vs VA Benefits?

It made me smarter to use your VA benefits instead of your Medigap benefits if you’re high on the priority list and the waiting period is not too long.

If you need prescription drugs or inpatient hospital care, it’s better to use your VA benefits since you’re getting low to no-cost health benefits.

If you are low on the priority level and face an extended wait time for medical treatment, you should consider using your Medicare and Medigap coverage instead.

Veterans Dealing with a Disability Claim Appeal

If you’re a Veteran dealing with a disability claim appeal, there’s a new tool that shows where your appeal is in the line and how long to expect to wait! The VA launched a new appeals status tracker so that Veterans with a compensation appeal can view their past and current appeals issues as well as receive alerts.

You can also view Medicare Advantage plans for disabled individuals here.

What’s the Best Medigap Plan for Veterans?

The best Medigap plan for veterans is dependent on their individual health care needs and budget. With 10 letter plans to choose from, you’ll be able to find a plan that fits your situation perfectly to give you the extra coverage you’re looking for.

Give us a call today for more information on plans and prices. You can also use our online price comparison tool to see rates side by side in your area.

Service-Disabled Veterans Insurance

Veterans who are granted a service-connected disability but are otherwise in good health may apply to VA for up to $10,000 life insurance coverage. The following is a summary of Service Disabled Veterans Insurance:

Service-Disabled Veterans Insurance

The Service-Disabled Veterans Insurance (S-DVI) program was established in 1951 to meet the insurance needs of certain veterans with service connected disabilities. S-DVI is available in a variety of permanent plans as well as term insurance. Policies are issued for a maximum face amount of $10,000.

Veterans who are granted a service-connected disability but are otherwise in good health may apply to VA for up to $10,000 in life insurance coverage at standard insurance rates within two years from the date VA notifies the veteran that the disability has been rated as service-connected. This insurance is limited to veterans who left service after April 24,1951.

Veterans who are totally disabled may apply for a waiver of premiums. For those who are eligible for this waiver, an additional policy of up to $20,000 is available. Premiums, however, cannot be waived on the additional insurance.

Eligibility For S-DVI Insurance

You are eligible if you if:

  • You were released from active duty under other than dishonorable conditions on or after April 25, 1951
  • You were rated for a service-connected disability (even if only 0%)
  • You are in good health except for any service-connected conditions
  • You apply within 2 years from the date VA grants your new service-connected disability

Eligibility For Supplemental S-DVI

The Veterans’ Benefits Act of 2010, provided for $30,000 of supplemental coverage to S-DVI policyholders. Premiums may not be waived on this supplemental coverage. S-DVI policyholders are eligible for this supplemental coverage if:

  • They are eligible for a waiver of premiums.
  • They apply for the coverage within one year from notice of the grant of waiver.
  • They are under age 65

Visit the Military.com Insurance Center to get information, advice, tips and to learn more about your life, auto, renters, and long-term care insurance options.

To apply for Supplemental S-DVI, you must file VA Form 29-0189, Application for Supplemental Service-Disabled Veterans (RH) Life Insurance or send a letter requesting this insurance over your signature. You must apply for the coverage within one year from notice of the grant of waiver of premiums.

Gratuitous S-DVI

Gratuitous Service-Disabled Veterans Insurance (S-DVI) is granted posthumously to Veterans who:

  • Met the basic eligibility requirements for S-DVI
  • Did not apply for S-DVI because of a continued mental incompetence due to a service connected disability
  • Died before the appointment of a guardian or within two years of such appointment

Veterans Affairs (VA) must receive an application for payment of Gratuitous S-DVI within two years from the date of the Veteran’s death.

If the person making the claim is mentally or legally incompetent, and did not file the claim in time, VA can receive the application within one year after incompetency ends.

Premiums For S-DVI Insurance

Premiums are based on your age and amount of coverage you purchase. Before you apply for S-DVI coverage, you should compare the premium rates to commercial insurance companies. If your disability is not serious, you may be able to find better rates from a commercial company. Under certain conditions, the basic S-DVI policy provides for a waiver of premiums in case of total disability. Policyholders who carry the basic S-DVI coverage and who become eligible for a waiver of premiums due to total disability can apply for and be granted additional Supplemental S-DVI of up to $30,000.

Service-Disabled Veterans Insurance

Veterans who are granted a service-connected disability but are otherwise in good health may apply to VA for up to $10,000 life insurance coverage. The following is a summary of Service Disabled Veterans Insurance:

Service-Disabled Veterans Insurance

The Service-Disabled Veterans Insurance (S-DVI) program was established in 1951 to meet the insurance needs of certain veterans with service connected disabilities. S-DVI is available in a variety of permanent plans as well as term insurance. Policies are issued for a maximum face amount of $10,000.

Veterans who are granted a service-connected disability but are otherwise in good health may apply to VA for up to $10,000 in life insurance coverage at standard insurance rates within two years from the date VA notifies the veteran that the disability has been rated as service-connected. This insurance is limited to veterans who left service after April 24,1951.

Veterans who are totally disabled may apply for a waiver of premiums. For those who are eligible for this waiver, an additional policy of up to $20,000 is available. Premiums, however, cannot be waived on the additional insurance.

Eligibility For S-DVI Insurance

You are eligible if you if:

  • You were released from active duty under other than dishonorable conditions on or after April 25, 1951
  • You were rated for a service-connected disability (even if only 0%)
  • You are in good health except for any service-connected conditions
  • You apply within 2 years from the date VA grants your new service-connected disability

Eligibility For Supplemental S-DVI

The Veterans’ Benefits Act of 2010, provided for $30,000 of supplemental coverage to S-DVI policyholders. Premiums may not be waived on this supplemental coverage. S-DVI policyholders are eligible for this supplemental coverage if:

  • They are eligible for a waiver of premiums.
  • They apply for the coverage within one year from notice of the grant of waiver.
  • They are under age 65

Visit the Military.com Insurance Center to get information, advice, tips and to learn more about your life, auto, renters, and long-term care insurance options.

To apply for Supplemental S-DVI, you must file VA Form 29-0189, Application for Supplemental Service-Disabled Veterans (RH) Life Insurance or send a letter requesting this insurance over your signature. You must apply for the coverage within one year from notice of the grant of waiver of premiums.

Gratuitous S-DVI

Gratuitous Service-Disabled Veterans Insurance (S-DVI) is granted posthumously to Veterans who:

  • Met the basic eligibility requirements for S-DVI
  • Did not apply for S-DVI because of a continued mental incompetence due to a service connected disability
  • Died before the appointment of a guardian or within two years of such appointment

Veterans Affairs (VA) must receive an application for payment of Gratuitous S-DVI within two years from the date of the Veteran’s death.

If the person making the claim is mentally or legally incompetent, and did not file the claim in time, VA can receive the application within one year after incompetency ends.

Premiums For S-DVI Insurance

Premiums are based on your age and amount of coverage you purchase. Before you apply for S-DVI coverage, you should compare the premium rates to commercial insurance companies. If your disability is not serious, you may be able to find better rates from a commercial company. Under certain conditions, the basic S-DVI policy provides for a waiver of premiums in case of total disability. Policyholders who carry the basic S-DVI coverage and who become eligible for a waiver of premiums due to total disability can apply for and be granted additional Supplemental S-DVI of up to $30,000.

Supplemental Health Insurance For Veterans

Military or Veteran Coverage

There may be coverage for veterans or military retirees and/or their dependents which coordinates with Medicare. Most common are:

  • Veteran’s Benefits
  • Tricare for Life – For military retirees
  • Civilian Health and Medical Program of VA (ChampVA) – For dependents of a living veteran with 100% service connected disabilities or who died as a result of the service-connected disability

For more information, contact your County Veterans Service Officer (CVSO). They help veterans and their families to obtain local, state and federal benefits for which they may qualify. They will also assist with the application process. Click here to find the County Veteran Service Officer in your county.

Veteran’s Benefits

Eligibility: A person who served in active military service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits. Reservists and National Guard members may also qualify for VA health care benefits if they were called to active duty (other than for training only) by a Federal order and completed the full period for which they were called or ordered.

Priority Groups: During the enrollment process, each veteran is assigned to a priority group. VA uses priority groups (group 1 through group 8) to balance demand for VA health care enrollment with resources. Changes in available resources may reduce the number of priority groups the VA can enroll. If this occurs, the VA will publicize the changes and notify affected enrollees.

Costs: There is no premium required for VA Healthcare benefits, however, some veterans may have co-pays to receive VA health care benefits and/or medications. Services must be received in a VA approved facility. (VA may reimburse or pay for medical care provided to certain enrolled or otherwise eligible veterans by non-VA facilities in cases of medical emergencies where VA or other federal facilities were not available. Other conditions also apply.) A three-tiered co-pay system is used for all outpatient services with some exceptions. Most Veterans are charged $8 for each 30-day or less supply of medication provided by the VA for treatment of conditions that are not service-connected.

Other Insurance: The VA is required to bill private health insurance for medical care, supplies, and prescriptions provided for treatment of non-service connected conditions. Generally, the VA cannot bill Medicare, but can bill a secondary health insurance for covered services, including Medicare supplement policies.

A common question from veterans is “do I need Part B of Medicare?” VA benefits are primarily available through VA facilities. If a beneficiary does not have access to convenient medical care or has an emergency for a non-service connected illness or injury and goes to a non-VA facility, having Medicare Part B would offer some coverage for services in those circumstances. (Note: If the veteran decides to waive Part B, they may get Part B back during the General Enrollment Period and may have to pay a penalty for not taking Part B when first eligible.)

“Do I need to join a Medicare Prescription Drug Plan? (Part D)” is another frequently asked question. If a veteran is eligible for VA benefits, including prescriptions, they would have “creditable coverage”, thus they would not need to enroll in Part D. A veteran may still choose to enroll in Part D if they need access to a local pharmacy or if they are eligible for the Medicare Part D Low Income Subsidy (“extra help”) which would lower the costs of their prescriptions.

For additional information on VA health care, visit the U.S Department of Veterans Affairs website.

Tricare

TRICARE is a regionally managed health care program for Active Duty members, Activated Guard and Reservists, Retired members of the Uniformed Services, their families and survivors. TRICARE brings together the healthcare resources of all military branches and supplements them with networks of civilian healthcare professionals to provide better access and high quality care while maintaining the capability to support military operations. Active Duty and Guard and Reserve service members are automatically enrolled in TRICARE Prime. However, military dependents and retirees must choose the TRICARE option that best suits their needs. For more information about TRICARE options, refer to HealthNet Federal Services, LLC (North Regions) at 1-800-874-2273 (1-800-TRICARE).

Prior to 2001, TRICARE coverage expired at age 65 forcing military retirees, their families and survivors to rely solely on Medicare. TRICARE For LIFE (TFL) provides military health care coverage to TRICARE beneficiaries 65 years of age or older. When TRICARE beneficiaries (other than eligible active duty family members) became entitled to Medicare Part A, on the basis of age or disability/end-stage renal disease and purchase Medicare Part B, they do not experience a break in TRICARE coverage. TRICARE for Life pays secondary to Medicare.

Eligibility: TFL is available for all dual TRICARE/Medicare eligible uniformed service retirees, including retired members of the Reserve Component who are receiving retiree pay, Medicare eligible family members, Medicare eligible widows/widowers, certain former spouses, and beneficiaries under age 65 who are also entitled to Medicare Part A because of a disability or chronic renal disease.

Cost: There are no enrollment fees for TFL. Beneficiaries, other than active duty family members, are required to enroll in Medicare Part B and to pay the appropriate Medicare Part B monthly premiums.

Benefits: For services payable by both Medicare and TFL, Medicare pays first, any other health insurance pays second, and the remaining beneficiary liability may be paid by TFL. For services received from a civilian provider, the provider first files claims with Medicare. Medicare pays its portion and electronically forwards the claim to TFL for processing. TFL sends its payment for the remaining beneficiary liability directly to the provider, and beneficiaries receive a Medicare summary notice (from Medicare) and a TFL explanation of benefits (EOB) that indicates the amount paid to the provider.

For services payable by TFL, but not Medicare, such as overseas travel, TFL pays the same as the TRICARE Standard Plan and beneficiaries are responsible for the fiscal year deductible and cost shares of the Standard Plan.

For services payable by Medicare, but not TFL, such as chiropractic services, Medicare pays as usual, however, TFL makes no payment. Beneficiaries are responsible for Medicare co-insurance and deductibles.

For services not payable by Medicare or TRICARE, beneficiaries are responsible for the entire bill.

Tricare for life Pharmacy Pilot Program: Beginning March 14, 2013, this new pilot program requires TFL bneficiaries living in the United States who fill select maintenance medications at a retail pharmacy to switch these prescriptions to the TRICARE Pharmacy Home Delivery system or to a military pharmacy. Medications included in the pilot which are not purchased via the Home Delivery system or from a military pharmacy after the start of this program will not be eligible for benefits after the 3rd fill and the beneficiary will be responsible for 100% of the cost. If the beneficiary has other health insurance with a prescription benefit or they are not part of the pilot or in some cases of personal need, hardship, emergency, or other special circumstances (such as living abroad or in a nursing home) the beneficiary will be able to request a waiver. They may opt out of the pilot altogether after using Home Delivery for at least 1 year.

Remember, Members enrolled in TRICARE for Life do not need to enroll in a Medicare Part D plan.

For more information on TRICARE, TRICARE for LIFE, and other TRICARE programs, visit Military.com benefits, Understanding TRICARE.

Civilian Health and Medical Program of the Department of Veterans Affairs (ChampVA)

CHAMPVA is a comprehensive health care program with which the VA shares the cost of covered health care services and supplies with eligible beneficiaries.

Eligibility: To be eligible for CHAMPVA, a family member of a qualifying sponsor cannot be eligible for TRICARE/CHAMPUS and must be in one of these categories:

  1. The spouse or children of veterans who have been rated permanently and totally disabled for service-connected disabilities by a VA regional office
  2. The surviving spouse or children of veterans who died from VA rated service connected disabilities
  3. The surviving spouse or children of veterans who were, at the time of death, rated permanently and totally disabled from a service connected disability
  4. The surviving spouse or children of military members who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).

For More information on eligibility, please see the U.S. Department of Veterans Affairs CHAMPVA website.

Benefits: The CHAMPVA program covers most health care services and supplies that are medically necessary. CHAMPVA does not have a network of medical providers. However, most TRICARE providers will also accept CHAMPVA patients. Go to TRICARE Your Military Health Plan to locate a provider in your area, then contact them to ask if they also accept CHAMPVA patients.

Most Medicare providers will also accept CHAMPVA patients. Medicare providers can be located through the U.S. Government’s Medicare website. Use the “Search Tools” at the bottom of that page to locate a Medicare provider. (Important Note: All hospitals that participate in Medicare, and hospital-based health care professionals who are employed by, or contracted to such hospitals are required by law to accept CHAMPVA for inpatient hospital services.)

CHAMPVA and Medicare: CHAMPVA is always the secondary payer to Medicare. As of June 5, 2001, Medicare beneficiaries are required to have both Part A and Part B of Medicare in order to be eligible for CHAMPVA. A beneficiary may not have any out-of-pocket expenses for health care services covered under Medicare and CHAMPVA.

A beneficiary does not need to enroll in Part D to maintain their CHAMPVA eligibility. There are some benefits of the CHAMPVA prescription programs that would no longer be available if the beneficiary did enroll in Part D. Specifically, the Meds by Mail program, through which maintenance medications can be obtained at no cost (no premiums, no deductible and no co-payments). CHAMPVA would pay secondary to the Part D plan, paying up to 75% of the CHAMPVA allowable amount. A beneficiary would need to use the Part D network pharmacies if enrolled in Part D.

For more information on CHAMPVA and other military benefits contact your local County Veteran Service Officer.

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