In last week’s newsletter, we covered the first five reasons a veteran with VA healthcare needs Medicare as well. (Read part 1 here) These five are:

1. VA healthcare is NOT insurance, and you can lose it if Congress does not provide sufficient funding annually.
2. Since it’s not insurance, when you eventually get it (because you will realize you need it), if you didn’t do so during your IEP (Initial Enrollment Period), you will incur lifetime penalties that can be very costly.
3. Copays in the VA healthcare system can be expensive, and Medicare Advantage plans often have $0 copay for routine services like doctor and specialist visits, urgent care, etc., depending on your plan.
4. Dental benefits – enough said on that one!
5. Emergency care outside the VA, which many believe will be covered by the VA and they will be surprised.

So, let’s look at the other five reasons. As before, there is a 6^th bonus reason at the end.

Second Opinions

If you have a complex condition and receive a diagnosis you question, where do you go for a second opinion if you have no insurance? Sure, you can pay for it out of pocket, if you have the money, but what if you don’t? If you can afford several tests and consultations and you agree with the second opinion, and feel their treatment modality is preferable, how do you cover it?

Remember, Medicare and the VA do not talk to each other. By having Medicare as a second option, you can choose to step out of the VA system to get the care you need.

Flexibility of Care

Let’s say the above happened. You had a Medicare Advantage plan that allowed you to get that second opinion. Now you need to get the treatment, but the plan you belong to doesn’t have the facility you require in network; hence you can’t go.

You are not married to your Medicare plan. If the plan you have doesn’t cover the needs you have, you can change your plan. There are some criteria, for example:

• If it’s not AEP (Annual Election Period, Oct. 15 through December 7^th), or OEP (Open Enrollment Period, Jan. 1^st through March 31^st), you will need an SEP (Special Election Period). Often, one can be found that will allow you to change your plan during the year.
• If you qualify for Extra Help LIS (Low Income Subsidy), you have a quarterly SEP for the first 9 months of the year. The last 3 months has AEP, so that’s covered.
• If you have a chronic condition, like cancer, diabetes, ESRD, etc. that triggers an SEP so you can change to a Special Needs Plan.

In other words, rarely is there a situation where one who needs to change their plan for a legitimate reason that they cannot.