Medicare and VA Benefits
You can use your Veterans Affairs (VA) health care benefits along with Medicare. Enrolling in Medicare will not affect your VA benefits. If you have VA benefits, you are not required to enroll in Medicare when you turn 65, but the VA recommends Medicare enrollment to cover non-VA medical expenses.
Do You Need Medicare If You Have 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.
How Do VA Benefits Work with Medicare?
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.
Prescription Drug Coverage Through VA Benefits or Medicare Part D
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 use your VA prescription drug coverage, you have to use the VA’s mail-order pharmacy.
- By going through Medicare Part D, you can get prescriptions from non-VA doctors and have them filled at your local retail pharmacy.
- Medicare Part D may also pay for medications that the VA doesn’t cover.
- If you ever lose VA coverage, you have two months to sign up for Medicare Part D before the late enrollment penalty kicks in.
If you have Original Medicare you may be able to find a Medicare Part D prescription drug plan with low or no monthly premiums.
Using Medigap or Medicare Advantage and VA Benefits
Medigap plans can cover out of pocket expenses if you have Original Medicare.
- You are enrolled in Original Medicare and have out-of-pocket expenses.
- You are enrolled in a lower priority VA group — and could lose benefits in the future.
- You don’t live near a VA hospital or other VA facility.
- You want to use local, non-VA hospitals.
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.
11 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, August). Medicare & Other Health Benefits: Your Guide to Who Pays First. Retrieved from https://www.medicare.gov/Pubs/pdf/02179-medicare-coordination-benefits-payer.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, August). Coordination of Benefits. Retrieved from https://www.medicare.gov/Pubs/pdf/11546-coordination-of-benefits.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, June 30). Medicare Secondary Payer. Retrieved from https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer
- U.S. Centers for Medicare & Medicaid Services. (2020, June 30). Coordination of Benefits. Retrieved from https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Coordination-of-Benefits/Coordination-of-Benefits
- U.S. Department of Veteran Affairs. (2020, April 30). VA Health Care and Other Insurance. Retrieved from https://www.va.gov/health-care/about-va-health-benefits/va-health-care-and-other-insurance/
- U.S. Centers for Medicare & Medicaid Services. (2020, April). Medicare Secondary Payer. Retrieved from https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/msp_fact_sheet.pdf
- O’Brien, S. (2019, January 3). Know a Military Vet Turning 65? Here’s How Medicare Can Work with VA Health Care. Retrieved from https://www.cnbc.com/2019/01/03/military-vets-can-use-both-medicare-and-va-health-care.html
- National Council on Aging. (2018, August 1). How to Use Veterans Benefits with Medicare. Retrieved from https://www.ncoa.org/blog/how-to-use-veterans-benefits-with-medicare/
- Healthcare.gov. (n.d.). Health Care Coverage Options for Military Veterans. Retrieved from https://www.healthcare.gov/veterans/
- AARP. (n.d.). I Am a Veteran with Health Care Coverage from the VA System. Do I Need Medicare as Well? Retrieved from https://www.aarp.org/health/medicare-qa-tool/does-medicare-work-with-veterans-coverage/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How Medicare Works with Other Insurance. Retrieved from https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance