Though internal cost structures vary from plan to plan, medical costs for TRICARE For Life or CHAMPVA-covered services do not change at all for those Veterans on the plan with those military benefits. Likewise, costs do not change for Veterans that are being sent to civilian providers under VA Community Care or treated in a VA facility.

For Veterans receiving care through their Medicare coverage only (i.e., with no help from military coverage) at civilian doctors, these Medicare Advantage plans have set copays and a maximum out-of-pocket ceiling, ensuring predictable medical costs that studies find to be consistently more affordable than Original Medicare.

Medicare plans are prohibited by Federal law from using any underwriting. That means no health screenings, waiting periods, or priority groups — as long as you have Medicare Parts A and B and live within the plan’s service area, you’re eligible to enroll.

The plan that’s right for you depends on your personal needs and the type of military coverage you have (VA, CHAMPVA, TRICARE For Life, etc.). Veterans Healthcare agents can review your situation and help identify which options may work best for you to consider.

At Veterans Healthcare, we only help Veterans and retirees with Medicare plans that come at no additional cost. In fact, you’ll actually receive money back each month via the included Part B Premium reduction!

We all know nothing is “free” — someone is footing the bill for your Medicare plan, but it’s the Federal Government, not you.

Part C: Medicare Advantage was created by the Federal Government in 1997 — private insurance companies are contracted, paid, and regulated to do the service work for Medicare, including additional benefits as part of the bundled package. The Government pays for the program, you pay some of your Part B Premium, and TRICARE For Life continues to act as secondary payor, picking up whatever Medicare doesn’t pay.

Because of your discounted Medicare Part B premium, your Social Security check will grow. The contracted insurance company communicates directly with Social Security behind the scenes, ensuring you get your increase.

If you’re not yet receiving Social Security, your discounted Medicare Part B premium will be applied to your current method of payment — whether that’s through automatic bank withdrawals or mailing a check.

This isn’t “free money” — the Government taking a lower Medicare premium out of your Social Security means you keep more of your money.

For retirees with TRICARE For Life and/or VA coverage, we only offer Medicare plans designed to work with your current coverage.

Nothing we do will alter your reception of prescription drugs, whether on-installation or through the VA. It will be exactly the same as it’s always been.

Medicare always pays first, with TRICARE For Life acting as your secondary payor. If you decide to switch to a Medicare Advantage plan designed with your military coverage and service in mind, those payor positions do not change.

Your Medicare Advantage plan, which administers your Federal Medicare Part A & B coverage, would pay first, and TRICARE For Life would continue covering all TRICARE-covered out-of-pocket expenses — leaving you with a $0 patient responsibility every time. The same is true for CHAMPVA-covered services.

Medical costs do not change for Veterans with TRICARE For Life or CHAMPVA, nor do they change for Veterans treated at VA facilities or referred to civilian providers under VA Community Care.

The main difference is in how claims are processed. Under Original Medicare, claims are transferred automatically from Medicare to TRICARE For Life, since both are Government programs. With Medicare Advantage, the claims process shifts from Government-to-Government to authorized private carrier-to-Government.

In this case, your provider bills the Medicare Advantage plan for rendered medical services, and the remaining balance goes to TRICARE For Life. The end result remains the same: you still owe $0 out-of-pocket.

However, as you know, civilian medical providers sometimes make billing errors. You may have received — or know someone who has received — a mistaken bill from a hospital that had to be returned with a note stating that you have Medicare and TRICARE For Life and should not be responsible for payment. Once the provider received this information, they were able to correct their billing and ensure your patient responsibility was $0.

These kinds of billing mistakes can occur under Original Medicare, and they can also occur with Medicare Advantage plans. That’s why you have us at Veterans Healthcare.

In the rare event of a mistaken bill or provider error, we step in to ensure a smooth experience. Veterans Healthcare partners with a professional billing office that specializes in resolving the occasional billing mistakes we’ve seen after helping thousands of retirees. Every Veterans Healthcare Agent has a direct line to this billing office and can immediately enlist their services on your behalf if a mistaken bill ever comes your way.

You’ll never pay anything for the support and resources you receive through Veterans Healthcare. Our mission is to make sure Veterans receive the benefits promised to them — and be there to help every step of the way. Out-of-pocket costs don’t change for TRICARE and VA-covered services, and in the rare event of a billing error, we’re here to quickly bring about a fast and stress-free resolution.

Every Medicare carrier is approved by the Federal Government before being authorized to offer Medicare Advantage plans. These authorized carriers cannot cancel your plan because of your age, health status, or how much you use the plan.

As long as you remain eligible for Medicare A & B, continue paying your portion of your Part B premium (the amount left over after the plan’s automatic Part B Premium Giveback benefit), and live in the plan’s service area, your coverage is guaranteed to continue.

The only exceptions are if you move out of the plan’s service area or if the insurance carrier decides not to renew its Federal contract in that area. In the rare circumstance that a plan ever ends or is discontinued, Medicare provides you with a special enrollment period to choose another plan or easily return to Original Medicare, with TRICARE For Life and/or VA coverage continuing as your secondary coverage.

Your Veterans Healthcare Agent will always remain by your side — and you’ll even have their personal cell phone number — to provide support and answer any questions. You will never lose coverage, and you are fully protected at all times by Federal Medicare rules and regulations.

While information about every Medicare plan is publicly available, many retirees are unaware of the specific plans we offer — designed with their military coverage and service in mind. As a result, they may be skeptical about the additional benefits available to them through these specific Part C: Medicare Advantage plans.

The plans we help retirees with are listed on medicare.gov, and TRICARE For Life states that they work alongside your current benefits. But if you haven’t read through medicare.gov or browsed TRICARE’s FAQs recently, you may not have heard about these specific plans.

Part C: Medicare Advantage was created by Federal Law in the 1990s, but although it is funded and approved by the Federal Government, the Government doesn’t directly advertise for private providers like Humana, UnitedHealthcare, or Aetna annually. Instead, the Government focuses on protecting Medicare beneficiaries, ensuring the program’s solvency and quality of care, and encouraging retirees to explore the options available to them every year.

Retirees and Veterans often wonder if the Medicare plans we offer limit the providers they can see. The answer is simple: they can, but they certainly don’t have to.

A Health Maintenance Organization (HMO) plan structure can limit you to a network of providers. If that doesn’t sound like the right fit for you, you can consider other options.

Today’s Medicare HMOs are vastly different from those of the past. The modern Medicare HMOs offered by the major carriers we work with include tens of thousands — even hundreds of thousands — of participating providers, while still offering nationwide access to emergency care.

A Preferred Provider Organization (PPO) plan structure allows you to use any doctor or hospital that accepts Medicare for covered services. Many retirees who aren’t comfortable with HMOs prefer this option.

If keeping your current providers is your priority, your licensed insurance representative from our team will verify that each of your providers accepts the plan you’re considering before guiding you through the application process.

Your providers matter to you, and they matter to us. That’s why we work only with Veteran-focused Medicare plans that offer broad, inclusive networks of accepting doctors. To ensure you have access to the care you need, we choose to work exclusively with the three largest Medicare carriers in the U.S. — UnitedHealthcare, Humana, and Aetna — rather than smaller, regional Medicare providers.

When you reach out to us — whether by phone or consultation request — a licensed insurance representative from our Veterans Healthcare team will personally connect with you. They’ll get to know you, learn about your unique healthcare needs, and discuss your current coverage and how you may want it to improve.

With your permission, they’ll walk you through how Part C: Medicare Advantage works, confirm your eligibility, answer your questions, and explore the most beneficial options in your area that best fit your needs.

If you choose to apply for a plan, we’ll ensure your trusted healthcare providers accept it. From there, at your request, we’ll guide you through the simple application. All you’ll need is your military ID, red-white-and-blue Medicare card, and a few basic details like your date of birth and address. After your application is complete, we’ll send it to you for review. Once you’re satisfied, you’ll sign it, and the application will be automatically submitted.

From that moment, your dedicated Veterans Healthcare agent is on your side. They’ll remain your personal point of contact, giving you their direct phone number for any questions or support you may need.

Your signed application will be submitted to the approved insurance carrier you chose. Once accepted, it will be sent to the Federal Government’s Centers for Medicare & Medicaid Services (CMS) for validation. Upon CMS’ approval, you will be sent your Medicare plan materials and ID card.

Once your Medicare plan is active, simply present your new plan card along with your military ID to your civilian healthcare providers to access your Medicare coverage. You’ll also use your card at the dentist, optometrist, and gym to take advantage of your new, no-cost benefits.

Plus, with lower Medicare Part B costs, your Social Security benefits will automatically increase — putting more money back in your pocket.

In order to use your Medicare plan and access your additional benefits, you’ll receive a Medicare plan card issued by the Federally approved insurance carrier through which you applied.

You’ll show that new card, along with your military ID, to your civilian doctors and healthcare professionals. Your Medicare plan will pay first, and your TRICARE For Life will continue to pay in secondary position, always picking up the charge that Medicare doesn't pay. All listed medical copays for TRICARE-covered services will be billed to and paid by TRICARE For Life – anything that TRICARE For Life covered before will continue to be covered in full. Additionally, any and all VA care you receive will continue without interruption or change. You’ll no longer need to present your Original Medicare card to civilian providers — simply keep it safe at home.

You’ll also show your new Medicare plan card to your dentist, optometrist, and gym to access your new, no-cost coverage at those locations. If your Medicare plan also includes an in-store grocery allowance or over-the-counter benefits, you may be issued a separate card through which you will access those values. You’ll automatically receive the money back through the included Medicare Part B Premium giveback, too.

One time you won’t show your new Medicare plan card is at the pharmacy to receive prescription drugs. Because these Medicare Advantage plans are designed with Veterans in mind, many do not include prescription drug coverage beyond what is covered by Medicare Part B. This is by design, as TRICARE For Life, Express Scripts, Meds By Mail, or local pharmacies — however you’re currently getting your drugs — will continue to give you medication coverage. Nothing has to change with your prescriptions.

A Medicare prior authorization simply means a healthcare provider gets approval from Medicare or an approved insurance carrier using Federal guidelines before delivering a service or treatment. Beneficiaries don’t have to take any additional steps, and these requirements apply only to scheduled services — not to emergency or urgently needed care, which are always exempt.

It’s important to note that Original Medicare already requires prior authorization for certain major services (like durable medical equipment), and additional requirements will take effect in 2026. For Federally approved Medicare carriers, prior authorizations are permitted under Medicare law but only in specific circumstances authorized by Medicare itself. These approved carriers must follow the same rules as Original Medicare — approving all medically necessary services and adhering to Medicare’s guidelines in the process.

At its core, prior authorization serves two main purposes — to prevent fraud and to protect beneficiaries.

Recent reports estimate that Medicare — and by extension, American taxpayers — lose at least $60 billion each year to fraud. This fraud can place strain on the program, contributing to increased healthcare costs, higher Part B premiums (which are projected to nearly double by 2036), and adding to the national debt. Prior authorization is one of the tools the government is increasingly using to combat this problem. By verifying that a claim, patient, and provider are legitimate — and that the service is medically necessary under Medicare law — prior authorization helps prevent fraud while also protecting beneficiaries.

In short, prior authorizations exist for good reason. They safeguard the Medicare system from fraud, protect vulnerable beneficiaries, and help ensure taxpayer dollars are used responsibly. Both Original Medicare and Medicare Advantage operate under the same Federal standards of medically necessary care, and the evidence shows that beneficiaries in both programs receive the care they need. As Medicare continues to evolve, prior authorizations will remain an important, if sometimes misunderstood, safeguard — one that strives to protect beneficiaries and preserve the program for the future.