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Do You Need Medicare If You Have VA Benefits?

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Do You Need Medicare If You Have VA Benefits?

Monday, October 9, 2017 10:20 AM

Are you a veteran with medical coverage through the U.S. Department of Veterans Affairs (VA) who is eligible, or nearing eligibility for Medicare coverage? If you already have medical coverage through the VA health program, you may be wondering if you also need to enroll in Medicare. The answer is that you could probably benefit from having both VA benefits and Medicare. The VA encourages you to consider enrolling in Medicare as soon as you’re eligible because Medicare and VA benefits don’t work together – and you may have to pay a penalty if you end up enrolling in Medicare later.

VA healthcare benefits typically only cover services received at a VA facility, and for Medicare to cover your care, you must visit a non-VA facility that accepts your Medicare coverage. Having coverage through both the VA health program and Medicare gives you wider coverage and more choices of where you can be treated. Therefore, Medicare coverage may be particularly important if, say, you don’t live near a VA facility or your local facility has long wait times. With Medicare, you’re not limited to being treated at VA facilities – you can visit one of the many doctors, hospitals, and facilities that accepts Medicare.

Medicare Part A (Hospital Insurance) and VA benefits

It is encouraged to enroll or keep your Medicare Part A coverage in addition to your VA benefits. You usually don't pay a monthly premium for Medicare Part A, sometimes called "premium-free” Part A, if you meet the eligibility requirements. Learn more about Medicare Part A.

Medicare Part B (Medical Insurance) and VA benefits

Medicare Part B can provide you with medical coverage and services outside of the VA health system. Therefore, it is recommended that you enroll in Medicare Part B in addition to your VA benefits. If you wait to enroll in Part B when you are first eligible, you will likely experience gaps in coverage and incur a penalty for each 12-month period you were without Medicare Part B coverage. Learn more about Medicare Part B.

Medicare Part C (Medicare Advantage) and VA benefits

If you need additional services or coverage not offered to you through your VA benefits, you may consider a Medicare Advantage plan. Most Medicare Advantage plans offer additional coverage, like vision, hearing, dental, prescription drug coverage, and/or health and wellness programs. These services are usually offered through your VA benefits too, however, a Medicare Advantage plan might be a better choice depending on the facility locations and your travel needs. Learn more about Medicare Part C.

Medicare Part D (Prescription Drug Plans) and VA benefits

You can have both VA prescription drug benefits and a Medicare prescription Part D drug plan, however you may not need one. With VA health benefits, you typically get premium-free drug coverage. However, if the VA-approved pharmacy locations or the Consolidated Mail Outpatient Pharmacy Program (CMOP), doesn’t work for you, then you may consider a Part D or a Part C plan with prescription drug coverage. Part D coverage may also work for your needs if you qualify for Extra Help (the federal assistance program that helps people with Medicare afford their Part D drug costs) or if your nursing home is outside of the VA health system and you need medications from the nursing home pharmacy. If you choose to enroll in Part D at a later time, you can do so without paying a penalty. Learn more about Medicare Part D.

Medicare Supplemental Insurance (Medigap) and VA benefits

When you sign up for Medicare during your six-month initial enrollment period, you have the option of purchasing a Medigap policy to help supplement the portions of your medical bills that Medicare doesn't pay, such as deductibles and copayments. If you prefer to use your Medicare Part B medical insurance to visit non-VA doctors because, maybe you don’t live close to a VA facility or you’re enrolled in a VA lower priority group, you may wish to choose a Medigap plan to supplement your Medicare costs. Learn more about Medigap.

For further information about finding a Medicare plan that works with your VA health benefits and individual needs, call 888-815-3313 – TTY 711 to talk with a Medicare.org licensed insurance agent.

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Last Revised 11/15/2017