Medicare and Veteran’s Benefits
How do they handle claims if you have both coverages?
Do you want to sign up for Medicare A & B?
Pros & Cons of having both VA & Medicare?
Frequently Asked Questions (FAQs)
How long do I have to wait to get into the hospital or see a doctor?
San Diego Union Tribune 4.13.2017 New Website to tell you
VHA’s enrollment system one year ago had roughly 867,000 “pending” records. VA’s OIG found that about 35% of the pending claims were for veterans who investigators determined were deceased (Muchmore, Modern Healthcare, 9/2) CA Health Line 9.3.2015
I have Medicare and Veteran’s benefits.
Who pays first?
If you have or can get both Medicare and Veterans benefits, you can get treatment under either program. * medicare.gov/32996 * 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, like in a hospital. Medicare cannot pay for the same service that was covered by Veterans benefits, and your Veterans benefits cannot pay for the same service that was covered by Medicare. You do not have to go to a Department of Veterans Affairs (VA) hospital or to a doctor who works with the VA for Medicare to pay for the service. However, to get services paid by VA, you must go to a VA facility or have the VA authorize services in a non-VA facility.
Are there any situations when both Medicare and VA can pay?
Yes. 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 does not pay for.
Example: John, a veteran, goes to a non-VA hospital for a service that is authorized by the VA. While at the non-VA hospital, John gets other non-VA authorized services that the VA refuses to pay for. Some of these services are Medicare-covered services. Medicare may pay for some of the non-VA authorized services that John received. John will have to pay for services that are not covered by Medicare or the VA.
Can Medicare help pay my VA co-payment?
Sometimes. The VA charges a co-payment to some veterans. The co-payment is your share of the cost of your treatment, and is based on income. Medicare may be able to pay all or part of your co-payment if you are billed for VA-authorized care by a doctor or hospital that is not part of the VA.
I have a VA fee basis ID card.
Who pays first?
The VA gives fee basis ID cards to certain veterans. You may be given a fee basis card if: •You have a service connected disability; •You will need medical services for an extended period of time; or •There are no VA hospitals in your area.
If you have a fee basis ID card, you may choose any doctor that is listed on your card to treat you for the condition. If the doctor accepts you as a patient and bills the VA for services, the doctor must accept the VA’s payment as payment in full. The doctor may not bill either you or Medicare for any charges. If your doctor doesn’t accept the fee basis ID card, you will need to file a claim with the VA yourself. The VA will pay the approved amount to either you or your doctor.
Where can I get more information?
You can get more information on Veterans’ benefits scrolling through this page and other pages on our site. by calling your local VA office, or the national VA information number 1-800-827-1000 . Or, you can use a computer to look on the Internet at www.va.gov. If you do not have a computer, your local library or senior center may be able to help you get this information using their computer.
If I have additional question on my Medicare coverage, who do I call?
1.800.Medicare ssa.gov
Or of course, this private website. [email protected]
VA Mission Act of 2018
Official Website
Beginning June 6, 2019, under the MISSION Act, * Brochure * FAQ’s * you’ll have more ways to access health care. This includes within VA’s network and through approved non-VA medical providers in your community, called “community care providers.”
Find VA Locations & Community Care Providers
Depending on your situation—for example, if a certain type of health service isn’t provided by VA—you may be able to go to a non-VA provider, using your VA coverage.
How does this program work with other Insurance?
Blue Shield Authorized Agent
No extra charge to you
Steve Video @ Blue Shield Headquarters
- #Get Quotes & Enroll with Blue Shield
- Individual & Family Direct *** Covered CA
- Medi Gap, Part D Rx & Medicare Advantage
- Employer Group
Here are a few of our recommended
NCLER resources for advocates working with Veterans:
- Resource Sheet: Serving Older Veterans: An Introduction to Veterans Benefits
- Webinar Recording: Legal Basics: Veterans Benefits
- Chapter Summary: Using Reasonable Accommodations to Prevent the Eviction of Elderly Tenants with Disabilities
- Practice Guide: Legal Issue Spotting, Intake, and Referrals
- Elder Justice Toolkit: Non-Litigation Strategies: Reporting
- Elder Justice Toolkit: Trauma-Informed Lawyering
NCLER’s full library of trainings and resources are available on the NCLER website,
Here’s what we have so far on taxes if you are in the military.
IRS has resources to help military personnel and veterans understand taxes
The IRS provides Tax Information for Members of the Military to help them meet their unique tax obligations. Here are some topics that affect current and former military personnel, along with resources where they can go to find more information.
Military status
A taxpayer’s military status affects their eligibility for certain benefits.
- Check out these links:
Military status
Combat zones
There are rules specific to those who are serving in a combat zone.
- Check out these links:
Tax Exclusion for Combat Service
Notifying the IRS by E-mail about Combat Zone Service
Overseas service
There are also special rules for people serving abroad.
- Check out this link:
Armed Forces Tax Guide
Special situations
Active members of the Armed Forces might have questions about travel expenses, IRA contribution rules, and moving expenses.
- Check out this link:
Armed Forces Tax Guide
Disabled veterans
There are resources available to disabled veterans to help them understand employment and retirement benefits. These resources help these veterans find out where to get free tax help. They can also find IRS forms and publications in formats accessible for people with disabilities.
- Check out these links:
Frequently asked questions about the Uniformed Services and Reemployment Rights Act and the Soldiers and Sailors Civil Relief Act of 1940
Resources for Disabled Veterans
Get free tax help
Most military installations offer free income tax assistance; contact your legal office for more information. Veterans may also qualify for free tax help at locations nationwide if they meet income or age requirements.
- Check out this link:
Free help from volunteers
Medicare Dual Coverage
# 02179
Our Webpage on Medicare & Dual Coverage
Coordination of benefits -
two or more insurance plans
VIDEO
Employer obligation to report # of employees to Medicare
Explanation from Cal Broker Magazine Sept 2019
Subrogation
Medicare's Right to collect from other Coverage
You're Medicare Advantage plan has the right and responsibility to collect - subrogate for covered Medicare services for which Medicare is not the primary payer.
According to CMS regulations at 42 CFR sections 422.108 and 423.462, Anthem MediBlue Access (PPO), as a Medicare Advantage organization, will exercise the same rights of recovery that the Secretary exercises under CMS regulations in subparts B through D of part 411 of 42 CFR and the rules established in this section supersede any state laws. Anthem MediBlue Access (PPO) Evidence of Coverage
Medicare & You - Mental Health
Medicare & Mental Illness # 11358 2 pages
Medicare & Mental Illness # 10184
Our Webpage on Medicare & Mental Health
Los Angeles Consumer Resources #Directory
Our webpage on EOC Evidence of Coverage - Plain English, even if they are 2 to 300 pages
Guide to Mental Health Benefits (The Mighty)
Compliance Assistance Guide from DOL.Gov Health Benefits under Federal Law
Mental Health Videos
- Mental Health Video - updates on Mental Health Parity - Mental Health must be covered the same as physical health
- Video Medicare-covered benefits for mental health.
- PBS Bedlam VIDEO In an effort to get to the bottom of the current mental health crisis in the U.S., psychiatrist and documentarian Kenneth Paul Rosenberg M.D. chronicles personal, poignant stories of those suffering from mental illness, including his own family, to bring to light this epidemic and possible solutions. Shot over the course of five years, Bedlam takes viewers inside Los Angeles County’s overwhelmed and vastly under-resourced psych ER, a nearby jail warehousing thousands of psychiatric patients, and the homes — and homeless encampments — of people affected by severe mental illness, where silence and shame often worsen the suffering. See Trailer Available till October 30th
- Sharp Health Care - Mental Health Videos - Play List
- Mental Health Insurance Coverage: Get the Whole Picture
CMS Learning Aid for Mental Health Professionals
See our Main Webpage on Mental Health
Veteran’s Benefits Henson Fuerst Law Offices
#Medicare10050 and You 2021
Everything you want to know - Read Along
Your Medicare Benefits # 10116
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Use our scheduler to Set a phone, Skype or Face to Face meeting
Technical Links
38 U.S. Code Chapter 17 – HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL TREATMENT (§§ 1710–1720G)
HOSPITAL CARE AND MEDICAL TREATMENT FOR VETERANS IN THE REPUBLIC OF THE PHILIPPINES (§§ 1731–1735)
PAYMENTS TO STATE HOMES (§§ 1741–1745)
SICKLE CELL ANEMIA (§§ 1751–1761_to_1764)
TRANSFERRED] (§ 1771_to_1774)
https://www.va.gov/healthbenefits/cost/financial_assessment.asp
Here’s a four page list where it’s spelled out
https://www.va.gov/healthbenefits/resources/publications/IB10-454_quick_reference_guide_income_and_assets.pdf
What definition or calculation of Income does the VA use to determine benefits?
What do I count or not count as income?
https://www.va.gov/healthbenefits/cost/financial_assessment.asp
Here’s a four page list where it’s spelled out
https://www.va.gov/healthbenefits/resources/publications/IB10-454_quick_reference_guide_income_and_assets.pdf
Medicare Part B Doctor Visits —
Medicare and VA benefits do not work together.
VA benefits will not pay for Medicare cost-sharing (deductibles, copayments, coinsurances).
VA health benefits to get coverage for health care services and items not covered by Medicare, such as over-the-counter medications, annual physical exams, and hearing aids
Medicare Interactive
Note that Medicare Advantage Plans, include Part D Prescriptions
See also:
https://www.mymedicarematters.org/2018/05/use-veterans-benefits-medicare/
https://www.aarp.org/health/medicare-qa-tool/does-medicare-work-with-veterans-coverage/
You mentioned that the VA will provide you with:
Full medical, dental, and eye care.
So, the choice is up to you each time whether you want to use Medicare and a Medicare Advantage Plan or the VA for your Medical. medicare.gov/node/32996
Dental & Eye care are basically not coverage by Medicare, so you can go to the VA on that. Kaiser Medicare Advantage, which doesn’t deal with brokers might cover some Dental & Eye Care.
https://medicare.kaiserpermanente.org/wps/portal/medicare/plans/explore/descriptions/southern-california/los-angeles
Summary of benefits
I’m a disabled vet with full permanent and total disability. I also qualify for Medicare.
How do the two programs work together?
Isn’t the VA supposed to pay my Part B Doctor Visits Premium?
You mentioned that the VA will provide you with:
Full medical, dental, and eye care.
So, the choice is up to you each time whether you want to use Medicare and a Medicare Advantage Plan or the VA for your Medical. medicare.gov/node/32996
Dental & Eye care are basically not coverage by Medicare, so you can go to the VA on that. Kaiser Medicare Advantage, which doesn’t deal with brokers might cover some Dental & Eye Care.
https://medicare.kaiserpermanente.org/wps/portal/medicare/plans/explore/descriptions/southern-california/los-angeles
Summary of benefits
Medicare Part B Doctor Visits —
Medicare and VA benefits do not work together.
VA benefits will not pay for Medicare cost-sharing (deductibles, copayments, coinsurances).
VA health benefits to get coverage for health care services and items not covered by Medicare, such as over-the-counter medications, annual physical exams, and hearing aids
Medicare Interactive
Note that Medicare Advantage Plans, include Part D Prescriptions
See also:
https://www.mymedicarematters.org/2018/05/use-veterans-benefits-medicare/
https://www.aarp.org/health/medicare-qa-tool/does-medicare-work-with-veterans-coverage/
Permanent & Total Benefit
Learn more here cck-law.com/permanent-and-total-pt-disability
What is P & T benefit?
Permanent & Total Benefit
Learn more here cck-law.com/permanent-and-total-pt-disability
Find an accredited Veteran Service Officer or Veteran Service Representative in your area to help you.
OR find your nearest VA Hospital or Clinic and see one of their social workers.
Healthcare benefits (VA’s In-Home Health Care) are much quicker than other types of benefits.
If your Father served one day during a War-Time period, he may be eligible for financial assistance for private in-home care and or to move to a living facility that provides care. That benefit is ‘Non-Service Connected Pension’ and the dollar amount increases by need.
If he is housebound it’s more, and if he needs daily assistance with daily living activities, there is the highest level of pay called Aid & Attendance.
https://www.va.gov/ogc/apps/accreditation/index.asp
(to find an benefits advocate)
To find a healthcare facility- go to:
https://www.va.gov/directory/guide/home.asp
You can also find information from your State Department of Veterans Affairs and or the National Association of County Veteran Service Officers.
If the VA does not help you, let your CONGRESSIONAL Representation know about it and ask for follow-up.
If the County or State level veterans affairs do not help you, contact your SENATOR and file a complaint.
I hope this helps.
Hannah A. Williamson
http://www.linkedin.com/in/hannah-a-williamson-USARMYVET
We’ve heard something about new rules for Aid And Attendance and Medicaid – Be sure to check that out. It’s NOT our area of expertise. veteranaid.org/can-you-have-medicaid-andor-social-security-and-still-receive-the-aid-and-attendance-benefit-aid-and-attendance-benefit-faq/
elderlawanswers.com/new-rules-will-make-it-harder-to-qualify-for-long-term-care-help-from-the-va
payingforseniorcare.com/longtermcare/resources/veterans_pension
My Dad is a Vet but trying to get those benefits could take months; and, too trying to find help has been too difficult. I am exhausted and do not know where to go from here. I am afraid my father will most likely die inside his apartment from lack of care. I just cannot do anything about it.
I need someone to help us with trying to get any benefits we can, and VA benefits but no one will help us
Find an accredited Veteran Service Officer or Veteran Service Representative in your area to help you.
OR find your nearest VA Hospital or Clinic and see one of their social workers.
Healthcare benefits (VA’s In-Home Health Care) are much quicker than other types of benefits.
If your Father served one day during a War-Time period, he may be eligible for financial assistance for private in-home care and or to move to a living facility that provides care. That benefit is ‘Non-Service Connected Pension’ and the dollar amount increases by need.
If he is housebound it’s more, and if he needs daily assistance with daily living activities, there is the highest level of pay called Aid & Attendance.
https://www.va.gov/ogc/apps/accreditation/index.asp
(to find an benefits advocate)
To find a healthcare facility- go to:
https://www.va.gov/directory/guide/home.asp
You can also find information from your State Department of Veterans Affairs and or the National Association of County Veteran Service Officers.
If the VA does not help you, let your CONGRESSIONAL Representation know about it and ask for follow-up.
If the County or State level veterans affairs do not help you, contact your SENATOR and file a complaint.
I hope this helps.
Hannah A. Williamson
http://www.linkedin.com/in/hannah-a-williamson-USARMYVET
We’ve heard something about new rules for Aid And Attendance and Medicaid – Be sure to check that out. It’s NOT our area of expertise. veteranaid.org/can-you-have-medicaid-andor-social-security-and-still-receive-the-aid-and-attendance-benefit-aid-and-attendance-benefit-faq/
elderlawanswers.com/new-rules-will-make-it-harder-to-qualify-for-long-term-care-help-from-the-va
payingforseniorcare.com/longtermcare/resources/veterans_pension
thx Steve