How Medicare and VA benefits work together
VA health care provides medical services to veterans who have served in the U.S. military. If you’re eligible for Medicare and VA benefits, you can use both types of insurance to broaden your healthcare coverage. Having both Medicare and VA health care can benefit you in many ways.
We’ll discuss how Medicare and VA benefits work together and how having coverage from both kinds of insurance will positively impact your health.
Key takeaways:
Having Medicare and VA health care can benefit you with access to more comprehensive coverage.
Your VA benefits only apply to VA-facilities, and Medicare can pay for services that extend outside these facilities. Every time you receive care, you have to choose if you’re using Medicare benefits or VA benefits.
You can enroll in a Medicare Advantage plan and receive benefits from VA health care. Keep in mind that out-of-pocket costs can vary and you may be restricted to a provider network.
What benefits do you receive from Medicare?
You’re eligible to enroll in Medicare once you turn 65 years old, or if you’re younger and you have a qualifying disability. Medicare has a few different coverage options:
Original Medicare (Part A and Part B): covers your hospital visits and outpatient services
Medicare Advantage (Part C): a private, bundled alternative to Original Medicare that often offers additional benefits like routine dental, vision, and hearing coverage
Medicare Supplement (Medigap): helps cover out-of-pocket costs for outpatient medical services that Original Medicare doesn’t cover
Prescription drug coverage (Part D): provides coverage for prescription drugs and can either be a standalone plan or included with a Medicare Advantage plan
Each of these coverage types have different premiums and costs associated with them, which is important to note for beneficiaries who also receive care from the VA.
What benefits do you receive from VA health care?
Your eligibility for VA health care depends on your service history, discharge status, income level, and other considerations. You’re generally eligible for VA health care if you served in the active military, naval, or air service and were discharged honorably.
The VA covers a wide range of services for free, or for a low cost:
Inpatient and outpatient services
Prescription medications
Medical devices
Preventive care
Specialized services to meet the unique needs of veterans, like mental health services
These services must be received at a VA facility for coverage.
Note that VA benefits and TRICARE for Life are two different programs, but both provide healthcare coverage to eligible military personnel.
Should you enroll in Medicare while you have VA benefits?
We highly recommend that veterans who receive benefits from the VA also enroll in Medicare once they are eligible. The VA has its own medical facilities where veterans can receive care, and coverage usually doesn’t extend outside of these networks. Enrolling in Medicare ensures that veterans have access to more healthcare facilities and services so they have comprehensive coverage. Additionally, you can avoid delays in your access to care if you have more choices for providers you can see.
When to enroll in Medicare
It’s important to know when to enroll in Medicare so you’re protected against delays in care and late penalty fees. The best time to sign up for Medicare Part B is during your Initial Enrollment Period or Special Enrollment Period if you have a qualifying event. If you miss your chance to sign up for Medicare, you’ll face a lifetime fee tacked on to your Medicare Part B premium. Funding for VA health care could change in the future—enrolling in Medicare is another way to ensure you have access to healthcare if you lose VA benefits.
How do Medicare and VA benefits work together?
If eligible veterans have Medicare and VA health care benefits, both types of insurance can work together to provide comprehensive healthcare coverage. With Medicare, you’re covered even if you don’t go to a VA hospital or healthcare provider. And receiving benefits from the VA means that you’ll be covered for any service that Medicare doesn’t cover, like routine dental care if you qualify.
Remember that each time you see a healthcare provider, you have to keep in mind which benefits you’ll be able to use.
If you go to a VA healthcare facility, you’ll use your VA benefits.
If you go to a non-VA facility, make sure that your provider accepts Medicare to use your benefits. This shouldn’t be a problem since 98% of providers participate in Medicare.
Giving the VA your Medicare insurance information
You can potentially reduce your overall out-of-pocket costs by having both Medicare and VA benefits. If you use Medicare to pay for non-service-connected care, the VA may use the insurance to offset part of your VA copayment. Similarly, Medicare could count your VA health care charges toward your yearly Part B deductible.
Medicare and VA health care prescription drug coverage
VA benefits typically include coverage for prescription drugs. Signing up for Medicare Part D can also be beneficial since you can use your coverage to receive medications from a non-VA doctor. Enrolling in Part D is also beneficial for two other reasons:
It can fill in gaps in the VA national formulary
You’ll be able to pick up your prescription at a local pharmacy rather than going through the VA mail-order system
Can you have a Medicare Advantage plan and VA benefits?
You can choose to enroll in a Medicare Advantage plan while receiving benefits from the VA health care. Veterans may opt for a Medicare Advantage plan if they want vision, dental, and hearing coverage outside of VA facilities.
However, out-of-pocket costs can vary between Medicare Advantage plans. If veterans want access to more providers, they should know that Medicare Advantage plans often restrict beneficiaries to provider networks. So you may experience similar limitations to access with a Medicare Advantage plan and VA benefits.
Comparing Medicare and VA benefits
Enrolling in Medicare while you have health benefits from the VA increases your coverage and access to providers, services, and prescriptions. Both types of insurance can fill in the gaps left from the other.
However, one concern that veterans may have is the cost of Medicare. Because everyone’s health and financial situation is different, it’s hard to say what your exact healthcare costs will be. If you’re worried about signing up for Medicare, one of our licensed Medicare Advisors can help you determine the right path for you. Call us at 855-900-2427 or schedule a time to talk for free, personalized guidance.