Medicare and VA Benefits

Having both VA benefits and Medicare increases your options for where and how you receive health care services.

VA benefits only cover health care you receive at a VA medical center, other VA location or a VA-approved facility. If you go to a non-VA authorized facility, Medicare may pay for health care you receive there.

You may also lose your VA benefits if Congress fails to provide enough money to pay for them in the future, according to the Department of Veterans Affairs website.

If you delay enrolling in Medicare and lose your VA coverage, you will have to pay a Medicare late enrollment penalty when you do sign up. The penalty for Medicare Part B medical insurance gets larger each year you delay and you’ll have to pay the larger fee for the rest of your life.

Medicare and VA benefits seldom work together. This is a major reason the VA recommends that veterans enroll in Original Medicare even if they have VA benefits.

In most cases, VA benefits and Medicare can’t pay for the same services. The VA pays for VA-authorized health care services or items while Medicare pays for Medicare-approved health care. You generally have to choose which to use.

There is no coordination of benefits between the two health care programs.

In some cases though, the VA can authorize health care services in a non-VA hospital. If the VA did not authorize all the medical care you received while there, Medicare may step in to pay for Medicare-approved services you received.

You may still have to pay for health care services that neither the VA nor Medicare cover.

If you have both VA and Medicare Part D prescription drug coverage, you have the option of using either to pay for your prescriptions.

VA drug coverage is usually less expensive than a Medicare Part D plan. As long as you have VA drug coverage, you can put off buying a Medicare Part D prescription drug plan without having to pay a penalty.

If you have Original Medicare you may be able to find a Medicare Part D prescription drug plan with low or no monthly premiums.

Medicare supplement insurance plans — also called Medigap — and Medicare Advantage plans are sold by private insurers that contract with Medicare.

Medigap plans can cover out of pocket expenses if you have Original Medicare.

Medicare Advantage plans offer an alternative to having both Medicare Part A and Part B.

Medicare Part A covers hospital costs and Part B covers doctor visits and other medical costs. Medicare Advantage plans cover everything Original Medicare covers, but may have extra benefits such as vision, hearing and dental coverage.

It’s important to remember that you cannot have both a Medigap and Medicare Advantage plan. You have to choose one or the other.