Ask Fitz -- Maura O'Toole (copy)

Maura O'Toole

Veteran Medicare Advantage Plans – VA/TriCare Coordination

Suppose you have medical and drug coverage through the VA/TriCare, there are some situations when it may still be beneficial to enroll in a Medicare Advantage or Part D plan as well. Let’s start by taking a look at the Part D drug benefit. If you are covered by VA/TriCare, the drug benefits are considered creditable by Medicare. So what does that mean? As long as you are enrolled in VA/TriCare, which is creditable drug coverage, you won’t incur a late enrollment penalty if you ever do need or choose to enroll in a Part D prescription plan.

In most cases, if you have VA/TriCare drug coverage, there are no premiums and low or no copayments for your drugs. However, you will have to have your prescriptions filled at VA pharmacies or facilities. Even though you have drug coverage through the VA/TriCare, in some circumstances, you may want to consider enrolling in a Part D plan as well. What are some of those circumstances when it might be beneficial to enroll in a Part D plan?

  • If you live a long distance from a VA pharmacy or facility
  • You live in a non-VA nursing home and want to be able to get your prescriptions filled from the pharmacy that works with your nursing home
  • You want to be able to have prescriptions filled at retail pharmacies
  • You do not want to use a VA provider to have prescriptions filled
  • You want to have access to drugs that are not on the VA formulary but may be covered by a Part D formulary.
  • If you qualify for full Part D Extra Help, also known as low-income subsidy, which may have lower coinsurance or copays than your VA coverage

If you have VA drug coverage and are thinking of enrolling in a Part D plan, it is crucial to understand that there is no coordination between the two different plans. Your VA drug will be filled at VA pharmacies and facilities with any VA copays or coinsurance applied, and your Part D prescriptions can only be filled at pharmacies in your plan’s network. Your Part D plans, copays, and coinsurance will apply.

Now let’s take a look at the medical side. While the specifics may be e a little different, the same fundamental reasons you would join a Part D plan are similar to the reasons you might consider joining a Medicare Advantage plan. Any medical services you need if enrolled in VA/TriCare will have to be received at a VA facility or provided by a VA doctor. What are some of those circumstances when it might be beneficial to enroll in a Medicare Advantage plan?

  • If you live a long distance from a VA facility.
  • The wait times for services at the VA are longer than you want.
  • You want to have access to benefits that are not provided by the VA/TriCare program but are by a Medicare Advantage plan. (transportation, fitness club memberships, free over the counter benefits, etc.)

Before you enroll in either a Part D or Medicare Advantage, talk to an experienced Medicare agent like Maura O’Toole from the FitzGibbons Agency to ensure you will not permanently lose any VA/TriCare benefits. You should also check with the VA/TriCrae to make sure as well. This could happen in some situations, and the last thing you want to do is make a change that excludes you from VA/TriCare coverage in the future.


Have further Questions? Just Ask Fitz!

Maura O’Toole

FitzGibbons Agency

44 E Bridge St, Suite 1

Oswego, NY 13126

(315) 312-0803


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