Is va creditable coverage for part d?

If you’re a veteran and eligible for Medicare, you may be wondering if your VA coverage counts as “creditable coverage” towards Part D. Well, buckle up because we’re about to dive into the nitty-gritty details of what creditable coverage even means.

What is Creditable Coverage?

Here’s the dealio: creditable coverage refers to any sort of health insurance or drug benefits that are at least as good as Medicare’s prescription drug offering. Basically, it just means that the insurance you have already provides similar or better medication coverage than what’s available through Medicare.

Why Does This Matter?

Alrighty, so why should ya care? If someone doesn’t have creditable prescription drug coverage before joining Medicare, and they decide later on down the line they want to enroll in a Part D plan…well, let’s just say there might be some pricy consequences (we’ll get into those soon enough).

Types of Creditable Coverage

There are several types of insurances out there that would count towards being “creditable” – including COBRA (who names these things?), TRICARE (which stands for Military Health System) – but today we’ll be focusing specifically on VA benefits.

TRICARE vs. VA

Although both TRICARE and VA offer healthcare services to military personnel/veterans/their families…they’re not one in the same! In fact (get ready with your bold letters)TRICARE is considered “creditable” while VA benefits do NOT necessarily meet this standard.

Whoopsie Daisy!

Wait wait wait – holdup. Did I just make your brain explode by nullifying all your previous knowledge about veterans’ benefits being superior??? Oh geez…

Let me rephrase: yes Virginia (no pun intended) , VA insurance can be perfectly adequate coverage for a lot of things. But, it’s the specific area of drug benefits that we’re focusing on here – and in that regard, VA has some restrictions.

Understanding Part D

Before diving further into what specific prescription drug coverages are offered through VA vs Medicare/Part D…let’s just do a quick overview on what your options even are when it comes to Part D coverage:

Enrolling in a Medicare Prescription Drug Plan (PDP)

Under this option, beneficiaries enroll in standalone (from original Medicare) prescription drug plans directly through private companies such as Humana or Aetna.

MAPD (“Maaahp Dee”)

Different from PDPs – these types of plans combine both medical and prescription drug benefits together under one plan. You guessed it – also provided by private insurance co’s!

Restrictions with VA Benefits

Alright enough chitchat – let’s get straight into those nitty-gritty restrictions I mentioned earlier!

To put it simply: if veterans only have VA prescription drug coverage (and no other supplemental creditable insurance) when they first become eligible for Medicare, they could face penalties down the line if they don’t switch/update their plan within 63 days after said eligibility period ends.

Example Scenario

Let’s break that down with an example scenario: Veteran Vince is age 71 and he currently gets all his prescriptions filled at his local VA facility pharmacy. However, let’s say Vince decides to debate enrolling in Original Medicare.(Gasp!) And then he realizes shortly thereafter… ah shoot..wait…I actually wanna enroll because “I just GOTTA HAVE THAT PART D”.

Guess what? If Vince doesn’t join within those initial seven months of eligibility during the year, but later decides†he wants too- yep you guessed right- His wallet will suffer consequences¹.

What Are These Consequences?

As mentioned in our brief intro section…if someone doesn’t have creditable prescription drug coverage when joining Medicare and they decide later on down the line they want to enroll in a Part D plan, there might be some monetary consequences.

Specifically: for every month that goes by without creditable prescription drug insurance, an individual’s premium increases by 1% once s/he eventually signs up. You heard me – it could reach as high as %30 (!) of the standard cost before you’re all said and done with waiting and not enrolling!

Wrap Up

So just to reiterate (because we used plenty of uncommon lingo in this article)…while VA benefits can work really well for quite a few healthcare situations…when looking specifically at prescriptions drugs Part D/Medicare may be necessary if an individual wants “creditable” coverage.

And while missing that initial eligibility period will lead to some undesired expenses – do remember -there are certain scenarios where one could apply for extra help(cost-sharing assistance). There ya have it folks!

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