A common question from veterans is whether they need Medicare if they already have VA benefits. The short answer to this question is no but with a big caveat.
If you already have VA benefits, you are not legally required to enroll in Medicare. However, veterans who sign up for Medicare receive additional benefits and more comprehensive health care coverage. Therefore, even though it’s not mandatory to sign up for Medicare, it is highly recommended.
In this article, we’ll discuss the reasons why having VA benefits and Medicare together is beneficial.
Health Insurance Options for Veterans
The Department of Veterans Affairs ensures that eligible veterans receive lifelong health care, with treatment and services delivered through a network of VA facilities.
The health coverage options available to veterans include:
- VA benefits
- Medicare
- Tricare for Life
To protect veterans’ best interests and ensure that enough funding is available through these various government-funded health programs to provide ample health care coverage, the Department of Veterans Affairs recommends that veterans acquire Medicare at the Medicare-eligible age of 65. This is true even when you have VA health coverage.
Why Veterans Have VA Benefits and Medicare
According to the United States Census Bureau, about half of veterans over 65 have Medicare and VA benefits. Though VA health benefits are extensive, they don’t cover everything. Further, despite the overlapping coverage, Medicare coverage can fill any gaps left by VA health benefits and other insurance.
One of the biggest motivators to sign up for Medicare is that VA benefits only provide coverage for care received at a VA hospital or facility unless you get prior approval. That means if you seek medical treatment outside of the VA system, your VA health care benefits won’t cover the cost.
Further, these approvals for care and medical procedures can be drawn out, sometimes taking weeks or months.
By contrast, Medicare has a more extensive provider network, giving veterans immediate access to many hospitals and doctor’s offices.
The chart below sums up where Veterans Affairs benefits end, and Medicare-covered services begin:
| VA Benefits | Medicare | |
|---|---|---|
| Urgent and Emergency Care | Yes | Yes |
| VA-approved prescriptions | Yes | No |
| Routine Eye Exams | Yes | Sometimes |
| Inpatient services | Yes | Yes |
| Preventative health care | Yes | Yes |
| Home health care | Yes | Yes |
| Hospice care | No | Yes |
| Skilled nursing facility care | No | Yes |
| Durable medical equipment | No | Yes |
How Does Medicare Work with VA Benefits?
Another common question is understanding who pays when you have both Medicare and VA benefits. In short, when you receive care at VA medical centers, the Veterans Health Administration foots the bill through your VA benefits plan. On the other hand, when the facility is Medicare-certified, Medicare will cover care.
Sometimes, non-VA facilities will authorize VA benefits coverage. Here, Medicare becomes a secondary payer, paying for services that are outside the scope of your VA benefits.
It’s also important to know that Medicare does not pay for services received at a VA facility. Therefore, most veterans find that VA coverage is still essential, even with Medicare benefits.
Medicare Costs
While some parts of Medicare are free, others will result in a small dent to your pocketbook. Still, the cost of Medicare’s monthly premiums will inevitably be lower than paying out-of-pocket costs when you receive health care services in a non-VA facility.
If you’ve had Medicare explained to you before, you already know there are four parts to Medicare, and eligible veterans can receive the following Medicare coverage:
Medicare Part A
Most veterans will be eligible for premium-free Medicare Part A. Part A covers inpatient hospital services, hospice care, and durable medical equipment. Veterans who have worked at least ten years (40 quarters) and paid Medicare taxes are eligible for Medicare Part A at no cost.
Medicare Part B
Medicare Part B includes outpatient healthcare services outside a VA facility. Again, there is no obligation to enroll in Medicare if you already have VA coverage, but if you later decide that you want Medicare Part B coverage, you will incur a penalty when you enroll.
Medicare Part C
Also referred to as a Medicare Advantage Plan, veterans with VA health care may still opt to enroll in Medicare Part C. These plans are available through private insurance companies and have relatively low health care costs for veterans.
Medicare Advantage plans can also serve as a safety net if you experience a medical emergency and cannot get to a nearby VA medical center for treatment. Instead of having to pay the full out-of-pocket cost for care in a non-VA facility, your Medicare Advantage plan will provide coverage.
Medicare Part D
Medicare Part D provides prescription drug coverage, but because VA drug coverage is already provided under the VA system, most veterans don’t need it. Delaying Medicare Part D until you need it is also an option. If, at some point, you cancel VA health care coverage, you can enroll in Medicare Part D without incurring any penalties.
Some beneficiaries in the VA health system still elect to enroll in Part D Medicare coverage for prescription drugs. This circumstance occurs when a veteran does not live near a VA facility or any VA providers or want to deal directly with a local pharmacy instead of going to a VA location.
Addressing Changing Health Needs
AARP also recommends carrying both Medicare and VA benefits to protect veterans against shifting costs and changes by the Veterans Administration that could reduce coverage. Further, enrolling in Medicare Part B, even if you think you don’t need it yet, could help you avoid costly penalties later.
Some veterans are also affected by the priority groups assigned to them. Lower priority groups may not be eligible to receive important medical services, including dental care and hearing aids. There could also be copayments involved for tests and procedures that might not apply when you have Medicare coverage.
Medicare Help for Veterans
There are a lot of myths about Medicare, including Medicare costs, and these myths continue to persist due to conflicting and sometimes confusing information. We encourage you to speak with a Medicare advisor to determine the best health coverage, including options for Medicare Advantage plans and additional prescription drug coverage.