How Medicare Can Affect Your Eligibility for CHAMPVA Benefits

Medicare enrollment will affect your eligibility for CHAMPVA benefits.  If you do not take certain steps on time, you may lose CHAMPVA eligibility.  Most people get enrolled in Medicare automatically when they become eligible at age 65.  You will need to take action before then to avoid interruption in your coverage.

Advertisement

End of Advertisement


When Medicare Coverage Begins

Usually, Medicare will enroll eligible beneficiaries in Part A automatically, 90 days prior to their 65th birthday.  In the majority of situations, people who are eligible for Medicare Part A must also get Part B to keep their CHAMPVA benefits.  You should get your paperwork completed before you turn 65 to prevent interruption in your coverage.

Types of Medicare Coverage

There are different classes of Medicare health insurance, listed below.

Medicare Part A

This is health insurance with no premiums, but it does have co-pays.  That means you share in the cost of your medical care.  You qualify for Medicare Part A if you are 65 years or older, or if you have qualifying disabilities.

Medicare Part B

This is insurance for outpatient care.  Part B has both premiums and co-payments.  Premiums are income-based.

In most cases, the CHAMPVA beneficiary must have Medicare Part B to retain CHAMPVA eligibility. Further, do not stop Part B or you will lose CHAMPVA.

Medicare Part C

This plan is known as the Medicare Advantage Plan, Part C or MA Plan.  The Advantage Plan gives you all the coverage you would get under Part A and Part B and may include additional coverage such as for eye care, dental care, hearing and prescription drugs.

Medicare Advantage Plans are offered by private health insurance companies approved by Medicare.

Medicare Part D

The last type of Medicare coverage is for prescription.  Co-payments and (usually) premiums apply.

You do not have to enroll in Part D to keep your CHAMPVA eligibility. If you do purchase it, you will no longer be eligible for the Meds by Mail program.

To learn more about Medicare, click here (external site).

How to Keep CHAMPVA When You Enroll in Medicare

In most instances, if the CHAMPVA beneficiary enrolls in Medicare Part A, he or she must also enroll in Medicare Part B to continue.  If you do not get Medicare Part B or if you cancel it, you will no longer be eligible for CHAMPVA coverage.

Try to do the following within the 90 days before your 65th birthday to ensure continuous coverage:

  1. Receive your Medicare enrollment information package. This should include your Medicare card that shows when enrollment begins.
  2. Submit VA Form 10-7959c: Other Health Insurance along with a photocopy of your Medicare card to the VA Health Administration Center.
  3. Receive your new CHAMPVA health card with the new extended expiration date.

Do You Need Both Medicare Part A and Part B to Keep CHAMPVA Benefits?

Most likely, yes.  But note the following special circumstances as described in A Handbook for the CHAMPVA Program:

  • If you are less than 65 years old and eligible for Part A of Medicare, you need to have Part B.
  • If you are more than 65 years old and have never been eligible for the no-premium Part A, you are not required to have Part B.
  • If your date of eligibility for CHAMPVA starts after June 5, 2001, you must have Medicare Part B.
  • If you were older than 65 years old and was already eligible for CHAMPVA when a new law took effect in 2001, you do not need Part B even if you got Part A.  But if you do have Prat B, you cannot cancel it without losing CHAMPVA benefits.

CHAMPVA Benefits You Can Lose with Medicare

Having Medicare coverage has its costs for CHAMPVA beneficiaries:

  • As said above and in the CHAMPVA Handbook, if you are required to have Medicare Parts A and B and you do not enroll in or you cancel Part B, you will lose CHAMPVA benefits.
  • If you enroll in Medicare Part D, you will no longer be eligible for Meds by Mail.
  • As a Medicare beneficiary, you cannot use VA medical facilities via the CHAMPVA Inhouse Treatment Initiative or CITI program.

How CHAMPVA and Medicare Work Together

If you are enrolled in both programs, CHAMPVA will be secondary insurance to Medicare.  That means the provider must bill Medicare and any Medicare supplement you may have before CHAMPVA.  Once CHAMPVA receives the remainder of the bill plus the Explanation of Benefits (EOB) from Medicare and the supplement (if there is one), it will process the claim.

One instance where CHAMPVA will assume the role of primary insurance is if you are age 65 or older, have Medicare and live abroad.  Medicare will not cover for your medical expenses abroad, but CHAMPVA will.  You must have Part B along with Part A.

See also CHAMPVA and Medicare cost summary and c0-payments.

Related Articles:

This website, CHAMPVAbenefits.com, is NOT affiliated with the Department of Veterans Affairs or any part of the U.S. government. Please DO NOT send us information about yourself such as your SSN, name, address, etc. for help with CHAMPVA…. The pharmacy network for CHAMPVA now is Catamaran (formerly SXC)…. Further, we cannot guarantee that the information here is accurate and up-to-date. To ensure you have the latest information, please visit the official CHAMPVA home page at http://www.va.gov/hac/forbeneficiaries/champva/champva.asp. Your use of this site means you agree to and understand this disclaimer. Thank you!

Post Footer automatically generated by Add Post Footer Plugin for wordpress.

Advertisement

End of Advertisement


email

Comments are closed.