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.

No Preexisting Condition Exclusions

If you needed to change your policy for, arguments sake, cancer, you need not worry that you will be rejected. Medicare Advantage has no preexisting condition exclusions, unlike MediGap policies after one’s IEP (Initial Enrollment Period).

Over-the-Counter Allowances

Many Medicare Advantage plans give OTC allowances that vary from $20 to $100 per month, depending on your plan. This allowance is for purchasing things you buy every month, out of your retirement check. If you no longer had to pay for them, or for a portion of them, depending on the amount provided, that’s money staying in the bank.

Free Gym Membership

There are three reasons retired people don’t go to the gym:

1. They are lazy.
2. They have a condition that doesn’t allow them.
3. They can’t afford it.

Gym memberships vary from $20 to $65 per month. Location and amenities typically decide the price range. While number two is hard to overcome, many a lazy retiree have come to enjoy the gym once they go. And since it’s at no cost, they can stay in shape and increase their social life with new friends.

BONUS: Worldwide Emergency and Urgent Care

As we get older and have more time, we want to travel. Whether you’re overseas or out of state, depending on the plan you choose, you can get worldwide emergency and urgent care benefits.

While each plan has their own conditions, some offer:

• The same copays you pay for emergency and urgent care locally, worldwide.
• Some offer up to a $50,000 limit.
• Some even offer air ambulance coverage with a 20% coinsurance.

When you consider the value of your Medicare benefits, it’s not something you want to leave on the table. As we age, its value only increases. And, depending on your financial situation, you may qualify for additional benefits like Extra Help and a Medicare Savings Program. If you qualify (over 23 million people do not know they qualify, since qualifications change annually), it can reimburse you for your Part B premium, any Part D premium, eliminate penalties if you’ve accrued any, and possibly eliminate copays and coinsurances, depending on what level you qualify for.

So, make sure you get your questions answered. Speak to a Medicare agent who specializes in veteran’s healthcare, and Tricare for Life and Medicare. If you live in Florida or South Carolina, you can fill out our contact form or call us at (727) 459-1887, and we will be happy to answer all your questions. We can also help you apply for Extra Help and a Medicare Savings Account if you qualify. Thank you for your service!